And Oscar goes to

 

My Reward ..

I get occasional rewards from my patients which to me is better than any Award .

I had recently taken up a metastatic rectosigmoid malignancy referred to me from another hospital who had plenty of issues .

 I saw him on Thursday in a wheelchair rolled into my consult room in Indira Gandhi coop hospital .

Dr ...he told me I havent eaten for few days as I cant swallow ,I have lot of pain in abdomen and back and I havent emptied my bowels for days .

All this are common in such patients .

His distended abdomen was firm so I was thinking of possibility of a sub acute intestinal obstruction ie the food doesnt move down due to obstruction in alimentary tract .

In advanced malignancy surgery to relieve it is not an option but no food by mouth ,IV fluids and medications give bowel the  rest it needs and it clears conservatively .

The other possibility was Acites ie fluid in Abdominal cavity which if confirmed by ultrasound of abdomen can be drained .

I ordered an USG abdomen and a plain x ray abdomen to look for obstruction.

USG confirmed moderate ascites .

Luckily the medical oncology physicians support my one man dept and they would do the tapping and taking care of patient as I would come only after weekend .

I admitted him and his fluids was drained by night more than 1600 ml .

The rest IV fluids and enema and medications made him much better and I was informed he has started taking soft diet .

Sorry for all these details .

These are routine for my Dr friends but Iam writing this as I wanted non medical people to know what we also do in palliative medicine .

Another lady admitted with advanced cholangiocarcinoma was sent by me for biliary duct stenting but since she had a cardiac comorbidity it was not done .

So palliative medicine is not just Morphine or end of life care or just tender loving pats or hugs .

Its judicious use of modern medicine to get the best qaulity of life for patient albeit not pinching his wallet too .

The best part of the story is  I called up patient yesterday and told him I could discharge him today but he told me 

Doctor first of all let me thank you for relieving me of pain ,relieving  my bowels and  my swelling abdomen and making me eat well .

Iam a happy man and I dont want discharge till you come back and I see you again and I can wait any time for that.

And I got my oscar and nobel prize together thus .

Film reviews..Avihitam and Bharatanatyam

 Avihitham ( illegal  Affair ) and Bharatanatyam 

Malayalam films review .

Only in malayalam can they take films with such taste ,simple story laced with intelligent humour without crutches of costly actors made in a shoestring budget and with every single actor doing his role to perfection and at end of film making us happy and satisfied .

Think in that sense Malludom is like ISRO consistently creating waves at minimal costs but maximal use .

Of course Mallu films too have got into the big star crores mega films cycle but the soul of it lies in topics of daily life blended to its soil culture and language with no pretensions .

Two films I would recommend to all are

Bharatanatyam ( Amazon prime ,Manorama max ) and Avihitham just released in Jio hotstar .

Bhatanatyam is a simple story of a family whose respected head is revealed to have a hidden side and family unknown for years and his illness brings them home !

How the elder son manages to hide all this from the nosy friends and neighbours and how one of them does detective work to prove his point of something strange in the house and how family fears the new wife and son have returned to claim the wealth and what happens after the man who caused all this died .

Its a laugh riot and a feel good film .

Avihitham again focuses on another mallu habit of snooping into others to expose affairs as a community .

moral policing by mallus is a realtime hobby .

Here too military strategies are made to catch culprits in a clandestine affair from an unexpected family lady and it all results in a surprising anti climax with a nice message to the community itself .

Real fun

watch both films.

Palliative medicine

 Iam a part time consultant in Palliative medicine 

( I prefer this label than Palliative care as today its diluted by volunteerism and tender loving care alone at times with medicine becoming a poor second ) .

There are many who can do TLC and good too it is so , specially in Kerala where most know about it and are willing to be part of it which is appreciable .

But to me with more than two or more decades in Onco hematology in India and abroad and my passion in chronic pain management specially in onco Palliative medicine ,  I want to focus on my skills and experience to be useful to my patients .

Though I go to Indira Gandhi Cooperative Hospital only three days a week ( I wanted it so at this time of my career ) 

 I look forwards to what I can do in those three days .

I still am in the benign shadow of a great physician  Dr VP Gangadharan Sir reknowned  medical onco hematologist and one who mentored me though now am  indepently in my speciality .

I can still walk over to his chamber to get his suggestions on patients of his and others .

To me a day in OP though not as busy as other leading consultants of the hospital is full and intresting .

I start off with my rounds of say 3 or 4 or 6 patients poring over thier files .

To me the diagnosis management complications in the file or EMR is easy to grasp by second nature and I can deduce what next for the patients well being for a best qaulity of life with  least expense .

My communication skills honed by time and study is useful to make them and family face the truth .

I use it to bring down anxiety and explain with honesty whats to be known .

Though often in my field disease progression is a reality the armamentarium I have in these times of referral to other specialists for palliative  Radiation at times surgery or palliative chemo or interventional pain management physio or occupational therapy to help in my aim of holistic well being of patient  using latest tech but only useful ones at least cost  .

Financial toxicity is a reality too .

As my field is low cost I use tests sparingly but dont shirk from using it when needed .

let me give some examples .

The Rotary club central Cochin has a scheme to help palliative dept in our hospital .

Apart from the ward they built they also reimburse cost of Fentanyl patches a costly pain reliving narcotic opioid .

This is great help to my patients who need it but cant afford it .

Yesterday I got a happy message from H ....with metastatic renal carcinoma that he just got all his Fentanyl bills reimbursed .

This has been going  on for last 3 years thanks to VPG Sir who was instrumental to its start and Vinu the points person involved in its sanction .

I also advise patients in need to get corporate help and in the many schemes of Govt specially the one by the  center the above  70 years senior citizens  PM Abay scheme of insurance upto 5 lakhs for all senior citizens of any îcome which includes pre existing diseases too .

Kerala never publicises such useful  central schemes .

its all politics

I dont know how selfishness can make people deny to the needy !

I tell families to apply to MP s health grants and avail railway and now KSRTC concessions .

My years of being a part of a NGO in my late daughters name has made me well versed to know the schemes available by our state itself .

Cochin cancer society of which am a part does so much like free stay in Snehaganga its resident  complex in Ernakulam for temporary treatment purposes where admission to hospital is not needed .

At times the happiness that comes from the relief of pain and other symptoms  of patients on admission or as outpatient is the best reward for me .

A 14 year old Nasopharyngeal carcinoma with blinding headache and facial pain smiling and  telling me after I saw her previous day

 Dr  I slept well last night 

makes me the happiest man on that day .

 I know once she is completes her treatment she would do much better .

But same could not be said of many of my patients now or in past.

I have fond memories of smiling and crying children of many ages and adults too over time .

Recently We just convinced a 80 year old colon malignancy patient whose family was not for any active treatment initially to get it investigated and finding she had an early stage malignancy with possible complete cure they agreed for surgery done sucessfully and well .

This is where oncology knowledge gives one an edge .

This is the advantage of working in a hospital with excellent  consultants in all fields so we can function as a team for the best of patient .

To me the 70 year old tall lanky advanced lung malignancy is a familiar figure last three years where I have been managing his pain as his cancer raced to his nerve plexuses and bones and we gave him radiotherapy , nerve blocks, chemotherapy ,and all possible pain medications 

He still smiles at me though now emaciated and terminal and I know his time is short .

Or the child I saw recently with an unfortunate sof tissue sarcoma occupying all her pelvis with so much pain she could only sit as lying down was painful .

We could to a small extent releive her with  opiods plus other analgesics , special cushions to spare pressure on her gluteal region though her disease is inoperable by extent and radioresistant sadly .

Many more such  experiences I can put here .

At times like this I do get annoyed with the power above harming such innocents while sparing the devils among us .

My speciality is humbling satisfying and fills me with gratitude .

To me a smile from my sufferers is the Oscar award I would never  recieve and am happy Iam a Palliative medicine consultant .

with every day an awakening .

Udaipur

 2020 February end ....

Udaipur the city of lakes a real jewel in the state of Rajasthan

It was  founded in 1559 by Maharana Udai Singh I and surrounded by the beautiful Aravalli mountains .and offers stunning views especially at sunset . 

The palaces reflect the architectural grandeur prevailing during the period of Rajputs and the scenic landscape is descriptive of how nature could be generous where it chooses to be. 

Jagdish temple built in 1651 an Indo-Aryan architectural marvel is dedicated to Lord  Vishnu  .

One can see beautiful wall carvings, and elephant sculptures 

The Lake palace is situated on the banks of Pichola Lake and is a blend of European, Medieval and Chinese styles of architecture. 

Another man made wonder in the city dominated by nature, Lake Pichola is surrounded by huge hills, magnificent palaces, temples and bathing ghats.

Jagmandir or Lake Garden Palace is said to have served as an inspiration for the Taj Mahal when Shah Jahan took refuge here in his younger days. 

This palace has a long history and is considered one of the symbols of friendship between the Mughals and Rajputs.

Octopussy the Bond Roger Moore starrer was shot at Monsoon Palace, Lake Palace, Jag Mandir, Fateh Sagar Paal and Pichola

Rajasthan or Rajputana as it was called before India got freedom is known the world over for its forts and more for its opulent palaces .

Unlike many erstwhile royal kingdoms the palaces are still owned by the royal families who had converted many into palace hotels and maintained well .

Most Goverment owned palaces have been lost to decay ,pilfering and poor maintenance .

 A garland given to a monkey is bound to be so .

Amongst the palaces the most remarkable and recent one is the palace complex in Udaipur the city of lakes .

It was built 500 years back over 3 generations of its Mahranas .

Udai singh II wanted to move way from Chitor as it was less safer to protect from enemies and Mughal emperor Akbar was repeatedly attacking too.

He asked a learned hermit about where to locate his new palace .

Udaipur was on banks of a huge lake called Pichola and was surrounded by forests and Aravalli mountain ranges .

So it was protected by nature .

Hermit blessed king to build his palace there 

So arose the Udaipur city palace ,the Jag mandir palace and Jagvilas the summer palace which today is Taj lake palace hotel .

The city palace itelf was huge at different floors and sprawled out interconnected by corridors halls courtyards etc .

Walking across it and climbing its floors were hard to knees so my wife vetoed it so i went alone ..

The huge gates of palace were called pols .

The main gate opened into tripol later hathi pol .

Today the main building is a well preserved museum which showcases art ,life,battles,of the royals .

Across lake pichola wedid go to jagmandir but not to jagvilas hotel ..

Some pictures

Kamalahassan

 

Today is Kamalahassans birthday .

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 !

Dr Ramakrishnan

 

With Dr Puzhankara Ramakrishnan  senior physician and Diabetologist at Rama varma club last year  when I was taken as a guest by my friend Ramesh Menon for Diwali celebs .

A few words on Dr Ramakrishnan sir ,

He is known for his clinical skills as an excellent Diabetologist too .

Hailing from a famous family in Ernakulam his father was an eminent lawyer .

Sirs lectures on medical topics in CME are well remembered for their depth and simplicity .

He is an excellent sportsman having lead St Alberts college cricket team getting first century ,and many more such landmark achievements .

He excelled in Hockey and football too .

An erudite traveller this scholar physician is an excellent  conversationist  . 

I wish him the very best

Dr .L.Subramaniom

 

Yesterday evening me and Premila  attended a concert which will remain etched in our memory as one of the best .

we were fortunate to listen to the legendary Violinist music maestro ,Physician , and Music Phd Dr and reciever of laurels from around the world for decades ,an Ambassador of Indian classical music and a pioneer in fusion music having collabrated with the greats like Yehudi Menuhin ,Ravi shankar ,George Harrison and many more ,the reciever of Padma Bhusan and padma shree .

He was actually there to recieve the felicitation  and Sangeetha Sampoorna award by Sree Poornathrayeesa Sangeetha Sabha celebrating thier 50 anniversary celebrations Swarna Poornatha .

The great artist came with his wife the most well known Kavitha Krishnamoorthy madam who had entertained all of us for years in Hindi playback singing and in other languages .

It was thier 26 th Wedding anniversary too and an auspicious day for them to visit the very precints of Sree Poornathrayeesa himself and pray to him in his temple before the programme .

Though Dr Subramaniam was born in Madras he had his maternal family hail from Tripunithura and he recounted his childhood stay near temple and his granny and cousins etc and how they would steal the excellent sweets she made before she gave it to them in time .

The award itself was presented by an equally erudite and eminient personality Dr Venu Rajamony IFS Retd who had officiated as Indias Ambassador to many countries and taken other responsibilities .

There could have been no better choice than him to felicitate a genius like 

Dr Subramaniam .

Thier friendship last 25 years more and Venu sir in his brilliant eloquence told us of how he had arranged an Yoga festival day instead of a programme of calisthenics when he was Ambassador to Netherlands in Amsterdam and Subramaniam sir with Kavita madam were requested and agreed to perform in the famous museum diatrict with 99 % audience of foriegners who were enthralled .

In another instance he as Ambassador to China had arranged Dr Subramanioms Violin to be part of Beijing  philharmonic orchestra an event attended by Indian and Chinese presidents .

Dr Subramaniam in his oration talked of his childhood his father a famous violinist and pioneer who wanted to take Indian classical violin to the world and he was happy he could do it with his equally adept brothers .

He recounted an anecdote in his young days when playing for the great musician Chembai Vaidyanatha Bhagvathar in Madras during the seventies .

At that time he was studying in Madras Medical College ..

Once in a concert with Chembai swami he did not want to attend as the next day was his MBBS final exams and he had to prepare ,

He requested Chembai to spare him that day but the great maestro told him I will make it short dont worry you can go earlier and will have time to prepare ,but in his own style went on in detail and poor Subramaniam had no options but to continue to play violin to him .

At end he took leave of Chembai who laughingly told the worried young violinist 

" Dont worry young man 

you will pass but remember MBBS will not give you a penny in your life !"

The great man had seen ahead of what 

Dr Subramaniom would become .

Humility comes with true greatness and one could feel it in the music that followed and his words .

There was a touch of mischief too in his humour ..

Though he was there to be felicitated he was kind enough to give us a feast of his music .

With able musicians of great experience accompanying him the three or more long pieces he played were marked by greatness and a complexity and sweetness that transferred each one of us to realms of happiness and peace we cannot describe as Indian classical music does even for novices like me with no knowledge of it ..

His tuning the violin to perfection during the perfomance showed his need for nothing short of the best wherever and whenever he plays be it in the United nations or in Thripunithura .

As we were requested not to record the programme using mobiles I could not take videos of his playing ,but I have tried my best in telling about it in words not assisted by AI which I never use or need for writing with passion.

#drlsubramaniam ,#Kavitakrishnamurthy,

#violinist ,#carnaticmusic,