why i write

रुबैयत ऑफ़ अ सरजरी रेसिडेंट

2011-03-15T23:05:00.000-07:00

awake for the anesthetist has discontinued
halothane and nitrous oxide
and lo the servants and residents have brought
the trolley to the table side

here with a metzenbaum scissor beneath the light
a bottle of blood, a pack of instruments
and thou! bagging beside me in the operation room
and the operation room is paradise enow!

dreaming when the suction catheter was in my throat
i heard a voice in distance cry
awake my little one and go to the ward
before the iv bottle runs dry

and as the monitors beeped, the patients stood before
the theatre shouted, open the door
you know how long we have been waiting
and once departed may return no more

now the new patient reviving old desires
the thoughtful resident to ot retires
where the white hand of Hunter on the knife
Puts out, and Lister from the ground suspires

Mayo is indeed gone with all his clamps
and Billroth's sharp scissor where no one knows
but still the drip her ancient water yields
and still a oxygen bottle by the table blows

come fill the syringe and in the fever of spring
the winter blanket of hospital fling
the student of night has but a little way in the ward
and lo! the student is on the wing

the moving scalpel cuts and having cut
moves on. Nor all thy piety nor wit
shall lure it back to cancel half a millimetre
nor all thy tears heal a millimetre of it

think in this battered operation room
whose doorways are alternate night and noon
how surgeon after surgeon with his pomp
incised his hour or two and went his way

they say the lion and lizard keep
the court where sushrut gloried and incised deep
and charak the great doctor, the wild goat
stamps on his head and he lies fast asleep

ah my beloved fill the vaporizer that clears
today of past regrets and future fears
tomorrow, why tomorrow i may be
myself with yesterday's seven thousand years

and those who husbanded the crimson fluid
and those who flung it the floor like rain
alike to

2010-12-22T05:58:00.000-08:00

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तुलिप शेती

2010-08-06T06:19:00.000-07:00

2010-07-30T06:39:00.000-07:00

झोप मुला झोप मुला, बघ हा अनेस्थेसिया दिला
नवरंगी औशाधान्नी भुशविली बघ ही ट्रोली
मोदभरे, ओटी भरे प्राणवायूते विखरे
शीतल हा नायट्रस पहा शुध्द हरन्या येत पहा
किल्बिलती बागडती, मेडिकल स्टुड्ण्ट किती
रव करती भ्रिन्गाटती ओतीचा अनुभव घेती
वोर्डात खोलीत रेसिडेंट मोदे मजा करी
झटकन बसे झटकन उठे, इकडे तिकडे फिरत सुटे
वासाने नाक कोंडे हरुनी शुध्दी निद्रा घे
दारातून डॉक्टर आला, मुला झोपवाया खचित तुला

x-ray pinups क्ष किरण सुन्दर्या

2010-07-25T23:23:00.000-07:00

थोमास स्टीफंस क्रिस्तदास यांची मराठिस्तुती

2010-07-25T22:17:00.000-07:00

जैसी हरळामाजी रत्नकिळा किं रत्नांमाजी हिरा निळा
तैसी भासा माजि चोखाळ भासा मराठी

जैसी पुस्पां माजि पुस्प मोगरी की परीमालाम माजि कस्तुरी
तैसी भाषां माजि साजिरी मराठिया

पखिआंमधे मयोरु ब्रुखिआंमधे कल्पतरु
भासांमधे मानु थोरू मराठियेसी

तारांमधे बारा रासी सप्त वारांमधे रवि ससी
या दिपीचेआं भासा मधे तैसी मराठिया

rubaiyat of surgical resident

2010-07-24T08:08:00.000-07:00

rubaiyat of a surgery resident

awake for the anesthetist has discontinued
halothane and nitrous oxide
and lo the servants and residents have brought
the trolley to the table side

here with a metzenbaum scissor beneath the light
a bottle of blood, a pack of instruments
and thou! bagging beside me in the operation room
and the operation room is paradise enow!

dreaming when catheter was in my throat dry
i heard a voice in distance cry
awake my little one and go to the ward
before the iv bottle runs dry

and as the monitors beeped, the patients stood before
the theatre shouted, open the door
you know how long we have been waiting
and once departed may return no more

now the new patient reviving old desires
the thoughtful resident to ot retires
where the white hand of Hunter on the knife
Puts out, and Lister from the ground suspires

Mayo is indeed gone with all his clamps
and Billroth's sharp scissor where no one knows
but still the drip her ancient water yields
and still a oxygen bottle by the table blows

come fill the syringe and in the fever of spring
the winter blanket of hospital fling
the student of night has but a little way in the ward
and lo! the student is on the wing

the moving scalpel cuts and having cut
moves on. Nor all thy piety nor wit
shall lure it back to cancel half a millimetre
nor all thy tears heal a millimetre of it

think in this battered operation room
whose doorways are alternate night and noon
how surgeon after surgeon with his pomp
incised his hour or two and went his way

they say the lion and lizard keep
the court where Sushrut gloried and incised deep
and Charak the great doctor, the stray buffalo
stamps on his head and he lies fast asleep

ah my beloved fill the vaporizer that clears
today of past regrets and future fears
tomorrow, why tomorrow i may be
myself with yesterday's seven thousand years

sp 12 day 3

2010-06-21T07:39:00.000-07:00

sp12 day 2

2010-06-21T07:05:00.000-07:00

yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
yhai national himalayan trekking program sar pass himachal pradesh harish saxena youth hostel
guna pani to funal pani
morning walk to the area before camp, among large pine trees. got up quite early, well before sunrise. suparna was also up. guna pani camp faces parwati range and one can see beautiful peaks on the east. just before sunrise, they looked golden red and it was a beautiful sight.
i have begun drinking tea once again. on the trek one will die without tea. breakfast was something or other, i really don't remember anything about the food we consumed during the trek. it was nothing to write about.
lunch packs and we were off.
the route took us behind the village along the side of hill, it was mostly bare, few trees, little shade. we walked slowly uphill for some time and then began climbing in earnest. the path was up a muddy, rocky slope. the trail was crowded as usual. it is difficult to see up with the cap on. without cap, sun is too hot. after climbing some distance we got to a place where some logs had fallen down. this was in a glade, some shade, some exposure. all kids started jumping and dancing for no reason, other than they being young.
lunch was provided on a rocky patch, on a steep hill side. there was a waterfall which we had to cross and there ketaki lost her glasses. lucky we had a spare.
after lunch, the path was in a deep forest, steep and we were all stretched out along the path for quite a distance. it was rather dull, no sun, we could not see much ahead and the curves obscured all view in front.
once again the guide was worried and did not let us pass. it was about to rain but did not rain. i wanted to hurry and reach camp before it started raining but he refused to budge. however, better sense prevailed and we managed to reach camp before rain started.
funal pani is in deep forest, on a steep slope. there is only enough plain ground to pitch a tent. all tents are at different levels. you have to walk some distance to reach the kitchen which is also perched on the hillside. there is hardly any place to stand, let alone sit. the tent which we got was found to be too small so we exchanged it with girls. they were only 10 and were also smaller in size.
toilets were behing the camp again on a steep slope, one had to take a winding path to get there. there was no cover and for getting cover, one would have to climb up and down for some distance. this time, they have prepared toilets and have put a indian style pot in it which gets clogged very soon. then people have used all space inside the toilet for their business and managed to soil everything. so messy. two wooden planks would have been enough.
well!
it was very dark so we ate dinner just at six and went to sleep by 7 pm. there was no space to hold the campfire and without a fire, no one was too keen on sitting around.
i had to repair some money belts and rucksacks. thread and needle are coming quite useful. had to repair shoes once again. i wonder if these shoes will last till we complete the trek. of course for rs.125/- one can't expect the moon.
while talking to the camp leader, one interesting piece of information. all the camps are connected to road by a short cut and all supplies are brought directly from the roadhead. there is no traffic along the trek route. the route is exclusively used for trekking by youth hostel.
the place near water pipe had become slippery and suparna slipped and fell. did not get hurt. the camp cooks are quite rude and give lot of lip. this is odd.
yha has not realized that the demography of trekkers has changed.
earlier, students were common, these days, it is mostly young professionals and families. they expect a little better service.
the tent slopes and mukund slipped out of the tent with his sleeping bag. i kept slipping down but once everyone is asleep, it hardly matters.
there are thirteen of us in the tent
me
suparna
anand panse
chaitra khulge
rohan sane
kishore dhone
alekh
pranav
amit
mukund
murali
harshad

kishore is a pilon with indian airlines
anand panse is a software engineer,
rohan sane has businesses in dombivali
chaitra works in sandvik
pranav is nearly as old as suparna and is in college
amit is doing msc
alekh works as designer in advertising agency
mukund and murali are in software, both were in oracle and have recently resigned
harshad works in industry in thane
works in software but in a foreign bank
suparna is student
i am the oldest person in tent and probably second oldest in the group.

we had a long discussion on history in the evening. amit started the discussion and said something incorrect. so i corrected him and then it went to the battles of panipat, indus valley civilization, satvahanas and so on, marathi riyasat etc etc.
most seem to have forgotten all history taught in school.
to bed

sp12 day 1

2010-05-24T21:53:00.000-07:00

trek began with a trip to manikarn, unchadhar by bus. the bus was supposed to come at nine but just to facilitate clapping, trekkers were made to leave at 8 am and then they all sat outside the camp till the bus arrived. how silly.
bus was very crowded and cramped but everybody managed to squeeze in.
reached unchadhar after nearly one hour and the trek began.
there was a group of stick sellers and we all bought sticks for rs.10 each. there were discrete inquiries for porters and only mrs khulge accepted. we had to descend some distance towards the river and then climb again to a nearby village and then cross it to reach the first camp at Gunapani.
the descent was not difficult but sun was up, it was nearly 10 am and very hot. there was little shade. crossed a small bridge and started climbing. climb was easy but steep. good footholds. there was some crowding on the trail. some time later, two women appeared with cans and offered 'lassi' for rs.5 a glass; choice of sweet or namkeen. it was wonderful.
then we climbed on the hill side to shila village where we again were swarmed with porters. in the village, local girls sang a song and danced which was filmed by many. we reached canteen after nearly two hours. two women had set up a tent and were busy preparing maggi, omelette, tea and had cold drinks, fruit juice. maggi was for rs.10 and omelette for rs 10. i ordered one maggi and omelette for everyone. ketaki, suparna, sanjeevani reached after few minutes. we had lunch of hot maggi and omelette and also ate packed lunch. weather was still warm, no shade, no water. post lunch, another climb, this time steeper and little slippery. tricky to negotiate with the pack but we managed somehow. reached pine forest and then the climb ended. a traverse in the forest took us to the camp.
camp is on a small grassy plain, trees all around, few houses nearby, orchards. plenty of water. canteen just before camp. five tents spread out in a small meadow. camp leader is from the hills but from uttaranchal and not himachal. a decent gentleman, what a contrast from the people at base camp.
i have not understood why trekkers are barred from reaching camp before a certain time. the guide was very particular about not going early. he made us stop on the way and was scared to reach camp before 3 pm. i think it is to avoid trekkers rushing about; or the guide hurrying them on the trail. but if we start early, walk at a steady pace, we can reach camp well before 3 pm.
lunch points and lunch canteens is a wonderful change from our kashmir trekking days.
last year cycling trek was along a regular road, so there were plenty restaurants, hotels, and plenty of food available everywhere.
but here also locals have smest a wonderful business opportunity and are busy making money. a plate of hot maggi and omelette works wonders at lunch time. so much better than eating cold rotis and baingan sabji. and good tea, even fruit juice and coke. what a life!
we settled down in the camp, had some tea. there was a song and dance in the canteen which was attended by all girls. i sat on a treetrunk and started repairing shoes. this seems a standard practice for me on treks. it was good i bought several tubes of superglue as mine and suparna's shoes had started to come unstuck. i fixed both with generous dabs of superglue and also gave some to chaitra.
also fixed plaster to manasi's shoes.
if i am to continue trekking, will have to get good trekking shoes.
still don't know all the members in the group. group is rather large.
a grand old man came to the camp and began a discourse on indian philosophy, swami vivekananda and rambled for a long time. it rained a little and the discourse broke off. then he landed in women's tent and continued his speech.
we had an early lunch and slept off.
there was a bit campfire without fire when everybody sang songs and dr rajan taught us the 'buzz' game.
needs sharp reflexes .
another game was like this.
one person stays inside the circle and is the master.
he points finger at anyone and the person on the left has to give a irrelevant answer. if the person at whom finger is pointed answers, he leaves the game.
if the answer given is relevant, even then the person who gives the answer leaves the game.
it was fun playing the game.
suparna lasted for a while, then mukund. eventually dipti won the game.
it was quite crowded in tent; camp leader offered to let some trekkers sleep in his tent so i slept there.
there was a big hue and cry in the night, probably some wild animals came to the camp.

pictures at picasa
sarpassmay122010

sar pass may 2010 trek

2010-05-24T21:05:00.000-07:00

yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pass
yhai youth hostels association of india sar pass trekking himalayan trekking sar pa
ss

sar pass trek organized by youth hostel was an interesting experience. base camp at kasol was something unique. kasol is a very small town in himachal pradesh, has one school, a post office, no bank, no government clinic. but it has more than twenty eateries serving excellent continental food all within a single square kilometre. the village is full of israeli tourists, italians, germans. all moving about in shorts and t shirts, boys and girls, with tresses, dreadlocks. at peace with the world. we felt outsiders.
several shops selling woolen items, felt curios, shirt tops, trousers, leather goods.

yhai base camp was one of the worst.
staff was extremely beurocratic, asking participants to fill forms, complete paperwork, stand in line, run to whistles. it was like being a german concentration camp. but there were no swastikas or guards with dogs and guns.
field director was seen, rarely heard, his was a benigh presence. another gentleman took pleasure in being rude.
a trekker had some trouble with teeth and asked if a toothpick could be had. he was fired and threatened with expulsion.
next day, a fracas developed with two other trekkers.
yhai officials ought to realize that the demography of trekkers has changed. there are few students and more professionals, more families, more people with good jobs paying good salaries. they are willing to take hardships but not rudeness.
food used to be terrible.
one person in office was most uncooperative. another person checking weight of sacks was very casual. he just used to ask the trekker if he would be able to carry it. there was no system of weighing the sack or anything.
during the acclimatization walk, three trekkers got lost and we had to hang about at the top doing nothing.
rock climbing and rappelling training was good. dev, yogi and his team were wonderful. yogi even demonstrated how not to fall during rappelling. all in all, base camp was not a nice thing. toilets were dirty. there were too many people about. at any one time, there would be at least four batches and some spillovers. each batch was at least 60 so, total 250 people. acute shortage of tents. inadequate staff. one person had to do all work. and there was too much work.
we spent two days at the base camp and left for trek on day three, ie 15th may

american ethics

2010-01-07T03:40:00.000-08:00

some time ago i uploaded several interesting pictures on a blog titled congenitalmalformations.blogspot.com.
these were images of children with various congenital malformations, which i had seen in all these years.
an american organization awhonn found the pictures, and sent me a mail requesting to use the images in their publications.
after several mails were exchanged, i received a mail asking for nine images.
i asked them for credit on the image and a small royalty.
it was agreed; i sent them the original image files and finally yesterday i received the royalty.
it speaks much for the ethical mind set of american people.
i am amazed.
the images were on net, the blog mentioned that the images could be used provided credit was given to me, they were supposedly royalty free.
the organization could very well have downloaded the images for free, sent me a mail thanking and used them.
or they might have used the images and i would have never known.
but they acted ethically, honestly and did everything by the book.
this was an international issue, there was no way i could have known about their use of images and sued them for infringement of copyright.
i am sure most of us, including myself have used images from net in our presentations, not for commercial use but still have used them without permission from the author.
we frequently download whole books, songs and much other stuff.
are americans more honest than indians?
i believe they are.
no wonder, every indian engineer or doctor wants to live in the usa

pakistan trip 2

2009-12-26T21:59:00.000-08:00

the same pickup truck then took me with rajkumar and others to the national institute of child health which was close to hotel. just before we reached hotel, a section of road was seen to be barricaded and lots of police and other armed personnel were about. this was the site of a recent bomb blast in karachi. i was told that jinnah's residence is also close to hotel. mehran hotel is situated on a busy thoroughfare, actually at a busy intersection of four or five roads. traffic is heavy and roads are full from 9 am to 8 pm. trucks, taxis, cars, bikes, rikshaws. few buses. all outlandishly decorated. people travelling on roof of buses. strange site in the middle of a great city. karachi is nearly 50 km square, one of the largest cities of the world and the largest muslim city in the world.
it has a sizable hindu, parsi and christian population too. many hindu names on buildings.
national institute of child health seems a medium sized hospital, plenty of people sitting around. it is a public hospital. inside is quite clean. little difficult to understand the geography but that is to be expected.
walked into iftikhar's office. i had seen some pictures of the apsp conference and had imagined iftikhar to be more elderly, spectacled. but he was very young, youthful, full head of hair, very fair, speaking urdu/english with punjabi accent. i remembered jagdish bhanu from aiims who looked very similar to him and had the same accent. how curious!
he was busy discussing video arrangements with someone.
i spent some time in the office and then he took me and rajkumar to hotel pearl for lunch. pearl is a typical five star hotel, also close to nich. iftikhar drove a car which looked very like maruti esteem, also manufactured by suzuki. suzuki also has a model exactly like maruti 800 which is called the mehran.
before entering the hotel, there was a barrier and security guards asked us to open the boot and bonnet and inspected. they also pushed a mirror underneath and checked the chassis. this was a new thing.
there was a mango festival going in the hotel, many new varieties of mangoes were displayed. i could only see 'langda' there. all other names were new.
two ultramodern looking girls, one in short top, sleeveless dress were sitting. hotel staff wearing smart salwar suits. no burkas or headscarves.
even in the hospital, no burkas. all were wearing a dupatta but thats all.
lunch was over so high tea was ordered, consisted of fruit juice, some snacks. we spent some time there and i was dropped at the hotel by iftikhar.
i was supposed to visit a shopping mall and then go for dinner with ifthkhar in the evening.
iftikhar turned up in the evening with two more surgeons, one from lahore, quite senior and old, dr daulatkhan from quetta. prof daulatkhan is the president of association. i had read his name and imagined him to be elderly but he was quite young, active, looked very fit. spoke with a strange accent but i could understand it.
one strange thing, there is hardly any difficulty in conversation. everyone speaks chaste urdu, which we don't find difficult to understand. some of our hindi expressions may be unclear to them but hindi films and music is so popular that even that should not be difficult.
we went to a shopping mall in some part of karachi and i bought some dress material. contrary to what others had written in their travelogues, the shopkeeper tried to overcharge but iftikhar intervened and got the price reduced.
the mall was not very big, had a fast food counter where we ate some burgers etc. it was crowded with families, children. again no burkas. all modern looking men and women, 'khate peete' types. fair, sharp noses. sharp features.
after eating, we returned to hotel. this was the end of first day, very busy and full of events.

pakistan experience

2009-12-20T19:41:00.000-08:00

preparations progressed well. exchanged few mails with iftikhar and got ready. reimbursement of expenses could not be done in advance so had to spend some money on my own for tickets. however, local hospitality and registration was done courtesy dr iftikhar jan.
i did not know what gifts to carry so asked ejaz on this issue. giving gifts to americans or europeans is very easy, one can give a statue of ganesha or budhdha and they are very happy. i remember my gifting a peacock feather fan to italians and how they were thrilled to receive real peacock feathers!
this would not have worked in karachi. ejaz suggested that i carry agate or other artefacts, but no religions statuary. which was fine. so went to panchakki and bought several agate animals etc. also bought several film cds and a ajanta/ellora cd.
left finally by train to mumbai. reached mumbai early morning, had bath and tea and left for airport. everyone was thrilled with the idea of my visit to pakistan.
pakistan international counter was crowded with bohris, everyone carrying boxes of alphonso mangoes. whole lot of people travelling. counter staff polite and polished as usual. surprise was another security frisking at the aerobridge by a separate set of people who did not wear a uniform, neither indian police or any other. two men and two women were frisking all passengers. the flight contained great many workers, it was going to jeddah from karachi.
cabin crew wore elegant salwar kamizes, good looking, smart. stewards and hostesses spoke chaste hindi or urdu. it did not matter. i could understand it very well.
food was excellent, an inkling of things to come.
outside view was unremarkable, i thought i saw the indus river as the plane flew over indus delta and we could see the innumerable rivulets.
karachi airport is rather stark, the field is large but terminal building appeared rather small. can not compare it with milan certainly or dubai.
it was very hot and humid outside the plane. bus took us to the terminal and a long wait began. after visa clearance, all foreigners had to fill a set of four forms, stick photographs and wait and wait and wait.
baggage was cleared fast. there was nothing to declare and nothing was found in the customs check.
foreigner clearance took a long time.
very young girls were at the counters, a web cam was taking pictures of all and something was being written. it was crazy. while this was going on, some others were seen to walk freely across the counters.
i did not understand what was going on but had to wait patiently.
it must have taken at least a hour and half to clear this and leave the airport.
at the barrier, four persons were standing with a placard. three surgeons and one mr rajkumar. we shook hands and got in a mercedes pickup. the bag was thrown in back and we got away.
traffic moves very fast, road is very good, at least six lanes. city seems very far from airport. someone asked me if this was my first visit and obviously the answer was 'yes'.
it was strange to see the sights of karachi. everything looked familiar yet different. same kind of people, same kind of faces, same cars, rikshaws, scooters. strange looking buses and trucks though. and more people in salwar suits. no women driving cars or two wheelers.
saw the pakistan air force museum on way. reached hotel mehran after almost an hour and got in.
receptionists were in elegant sarees, no burkas were in sight. a very modern and smart appearance. i saw a girl wearing sleeveless blouse and skirt, sitting in restaurant. two women smoking!
this is something one would rarely see in mumbai.

pakistan trip

2009-12-20T19:15:00.000-08:00

i joined the pakistan pediatric surgeons chat group sometime in 2002 or 2003. problems were similar, situation was similar, there was much to discuss, much to exchange, much to learn. i found the group quite academic, discussing administrative and other issues from time to time but mostly devoted to practical patient issues. as usual, there were few who were very active, more responders and many more lurkers. but that is how most groups are.
then sometime in dec 2003 or jan 2004, there was some discussion on the group about forthcoming national conference to which i received an invitation. then another invitation for the 'basant' festival in lahore was received. it was not possible to attend either.
then a meeting in may-june 2004 on megacolon was announced at the national institute of child health in karachi. for this the invitation came from prof iftikhar jan and i thought i might try and attend this.
some time before this, i had began doing single stage endorectal pullthrough for megacolon which was a advance as very few people in india were doing this at that time. this was worth presenting and i had some videos, photographs of the procedure.
thus the process began.
i received the letter of invitation and then applied for visa.
it turned out that one had to visit the pakistan embassy in delhi in person and apply. this was incorrect as i later found out and after spending money on air fare.
a trip to delhi had to be arranged at short notice. there were no direct flights to delhi then. so it had to be via mumbai.
visa forms were not available for download on the net so they had to be procured in the embassy. there were few agents here who were conversant with pakistan visa procedure.
went to mumbai in the night and caught the first flight to delhi.
reached delhi some time around 9 am and managed to reach embassy by 930 am.
window closed.
there were few sellers roaming around on streets selling visa forms and i bought a set of four for rs.20.
the filled the forms and reached window where no one was standing in line.
cought the attention of person inside and gave him forms. he accepted them happily though the time was over and did not bother to check bonafides, whether i was submitting forms in person or whatever. i suppose anyone could have submitted the forms. the visa fee of rs.15/- by bank draft was submitted. visa issue would take few days so i left the documents with him and decided to come back and ask rajendra deshpande to get the passport later.
so back to airport by taxi, aurangabad flight was ready to leave and back to aurangabad by evening. did not stop in mumbai. called ushamaoshi from the airport. met dr nandedkar in the plane and had to do some dodging to avoid disclosing the purpose of my visit.
plane hardly had any passengers, and after aurangabad, it was nearly empty.
the gentleman sitting behind was hungry and asked for a refill of the vapid airline food. some hunger!
so got back and three days later, passport was sent to me with visa stamped. however, it was for the wrong period so it had to be sent back and revised.
so at last, a big hurdle was over.
mumbai karachi flights had just began. earlier one had to travel to pakistan via shrilanka as all direct flights were stopped.
this was lucky. so booked tickets on pakistan international mumbai-karachi flight, leaving mumbai at 8 am.
and began preparing the presentation and video.

2009-12-19T05:35:00.000-08:00

last week we visited a manganese ore mine in maharashtra/madhyapradesh. entry of non authorized persons in underground mines is prohibited so i will not mention the place.
it was a strange but educative experience.
george orwell in 'road to wigan pier' describes the world of coalmines and coal miners in wales. i had read that many years ago but this was a first hand experience of the underground world of mines and miners.
it is a strange world, dark, not silent but full of strange noises, hot, humid. it is like walking in a dark maze. strange machinery is moving, people in hard hats, headlights, working very hard but looking very glamorous nevertheless.
one plays with fire, with one's life at all times and works very hard.
our life is a luxury it seems.
the daily routine of a mine consists of drilling throughout the shifts, they make about 20 holes in one hour. the drill is so heavy that it takes three men to hlld in place and to work it.
it makes a very loud racket. loads o fdust flying around.
no worker was seen to wear ear or dust protection but i saw one engineer wear a mask.
there is water underfoot. pneumatic pipes running everywhere. electric wires along walls.
strange niches and galleries everywhere.
rails underfoot with trolleys.
staircases, no laddes.
at one point, i had to climb down 90 feet straight down . afer spending some time there, i had to climb u p ths same straight up.
and thw workers were doing it as if going for a walk on the beach.
no wormsn works underground but they work on the surface breaking ore, washing it.
that too is heavy work

mountain photography dos and don'ts

2009-12-03T07:29:00.001-08:00

dos
1. best position of sun when there is mist around is facing the camera
2. shadows should fall towards the camera
3. close shots of snow covered buildings may be taken with side or back light
4. shoot when there is enough light and shade to render structure of hills
5. best time to take photographs is early morning and late afternoon
6. cloud formation is very important for the mood of a picture
7. to emphasize the height of a majestic cliff, include strong foreground rock, village or tree. a figure may improve composition but will not provide scale
8. snow covered landscapes are best pictured when snow is clean
9. snow pictures are made in sunlight.
10. use medium yellow filter for best results of sky and clouds
11. deep yellow, orange and red filter will give good distance penetration

don'ts
don't photograph on a hazy day, it gives flat and lifeless pictures
don't picture mountains with overcast skies or a cloudless blue sky
always include some scale object with mountains
don't picture snow when sun is high
don't take pictures in midday
don't expose on a flat area
don't take large areas of snow
don't tilt the camera

personal hygiene/care of clothes

2009-12-03T07:20:00.000-08:00

hygiene is important in mountains and during trekking.
while trekking and climbing body sweats even if one may not feel hot. sweat dries on feet, in groin and armpits. dirt gets caked up on perspiring body and pores are clogged. there may be chapping and rash in groin. one can not shave while trekking. even bathing is difficult.
it is not possible to have a hot bath in mountains. it is not advisable to bathe in cold water particularly at high altitudes.

sponging
if you can get a basin full of hot water, thorough sponging with soap and water followed by clean water and rub down the a dry towel and dusting with talcum powder is a good alternative to hot bath.
using two napkins, one soaked in hot water and other for drying helps.
change underwear after sponge bath.
keep a spare change of underwear in the rucksack. wash underwear and dry it as often as possible. if washing is not possible, air it and dry it. give it a rubdown and dust it with talcum powder. dirty clothes are less warm. their insulating quality is reduced by the amount of caked dirt on them. dirt is cold.

care of feet

2009-12-03T07:11:00.000-08:00

to avoid sore feet
remove boots as soon after a hike
wash feet as often as possible
dry feet thoroughly, especially between toes
wash socks as often as possible

to harden feet
wash feet in cold water and soap freely
rub soles with soap or grease
soak feet in salt solution
apply spirit to soles of feet

care of socks
if socks are torn, put a thin piece of cotton and paper over the torn portion
mend always from inside, edges must be cut. don't leave knots or projections
wash socks whenever possible
woolen socks are likely to shrink
change socks from right to left and vice versa
carry enough pairs on a long trek

footwear
boots/shoes should not be too tight or loose
fitting should be tried with proper socks and in standing position
try walking some distance in the shoes
uppers should fit in smooth and not bulge out
fitting should be tried in the afternoon or evening
don't use shoes which have not been used for a long time
keep footwear very clean
trim nails before putting on shoes

if blisters form
clean with soap and water
puncture the blister with a sterile needle. (pass needle through a flame)
soak all fluid
do not remove skin
apply adhesive plaster

prevention of blisters
apply generous amount of powder on the feet before wearing socks
apply more powder in the shoes before wearing shoes
apply vaseline to feet, specially on toes and bony parts

trekking rules according to yhai

2009-12-01T05:49:00.000-08:00

mountaineering dos and don'ts
1. pollution
camp site:
camp site usually satisfies basic requirement like availability of flat ground, closeness to clean water, orientation of slope, direction of wind, shelter from rain and snow etc. other parties have used the camp before you and others will use it after you have left. so leave the camp site cleaner than you found it.
a. all litter should be kept in one place
b. all garbage to be burnt should be collected in one place away from camp site and burnt. members responsible should ensure that all garbage is burnt and the ashes are covered with earth.
c. garbage which can not burn, glass bottles, tins, plastic should be collected separately and either carried back to base camp or buried away from the camp
d. nothing should be thrown in the river/stream
e. latrines should be allotted to members as soon as they arrive in camp
f. shallow latrines should be dug if the camp is going to be used for some days. otherwise, area away from camp, and downstream should be used as latrine area and each person should be instructed to cover nightsoil with earth. gravel, sand or fine scree should be piled in latrine area in advance.
g. separate latrine areas should be provided for men and women
h. sanitary napkins should not be thrown in water or in toilet/latrines but should be burnt; sanitary napkins are not biodegradable and should not be left in the campsite
i. when camp is being abandoned, all chullahs should be broken, all scars of fire covered with earth, all wood piled in one place, all garbage suitably disposed off and area made as natural as possible

on the march:
no litter should be thrown on the wayside. this includes toffee wrappers, cigarette packets, paper. all litter should be carried to camp and burnt.

conservation of flora
fire hazard: all fires must be put out before leaving a camp site. some hill people are superstitious about completely extinguishing a fire. in such a situation, a couple of embers can be left, surrounded by a ring of stones, and covered by a layer of ash.
burning cigarette stubs should not be thrown but completely extinguished.
no tree should be cut for firewood. juniper bushes should not be burnt. only dead branches and twigs should be collected for burning

conservation of wildlife
killing of animals/birds is prohibited

reporting
all trekkers are requested to report if any trekker is found indulging in polluting the campsite or stream; burning of trees, killing animals/birds

mountain manners

on meeting another climbing party or local inhabitant, a cheery greeting should not be forgotten. you may get useful information from them and save yourself some trouble.
if there are other groups on the track, maintain a distance in front or rear from the other party and do not mix the groups.
if you have to overtake other groups, please ask the leader of the group and seek his permission so that he can halt his group and allow you to pass his group.
walk at a steady rhythmic pace, maintaining the cadence. do not rush up hillsides. do not try to show off.
all members should walk at the pace of slowest member, especially at bottlenecks and difficult patches.
the leader should be last person and should check that all members are present from time to time.
don't lose your patience with a local inhabitant who tells you the distance in terms of time. they are used to walking in hills and can walk much faster than you.
respect social customs of local people. do not argue with them about religion, social customs, habits.
respect their womenfolk. do not indulge in eveteasing.
any important information such as a landslide, broken bridge, breach in track should be imparted to the nearest village headman and all parties on the track.
never throw stones down the slope or in water. a stone travels at very high speed and can severely injure others. if stone is dislodged and starts falling down the slope, give a warning to others by shouting 'stone' or 'paththar' loudly.
rowdy and noisy behaviour should be avoided. boisterous shrieks, whistles can distract others and cause serious accidents. don't wave handkerchiefs or wave your arms about as these are distress signals and can cause alarm in others.
in the camp, do not scatter your equipment or belongings indiscriminately.
do not take undue risks, avoid bravado. no one is greater than the mountain. mountains dont forgive or give you a second chance. be very careful and don't attempt things which you are not trained in.
before leaving camp, inform others where you intend to go, when you intend to return and what route you intend to take.
taking undue and uncalculated risk is not to be confused with dash and courage

camp customs
do not enter the tent with shoes; this will spoil the ground sheet. sit inside the tent with feet outside, remove shoes and keep them under the tent flap
never wash upstream from campsite or where other people may be drawing drinking water
check all streams for at least 400 yards upstream and make sure you are not downstream any washing area
only take water which is flowing fast, and not from a stagnant pool
drinking and cooking water must be drawn upstream; washing and bathing should be done downstream
wash mugs and dishes immediately after meals

duties of group leader
a group leader has responsibility to look after the physical, mental and psychological well being of the boys and girls in his charge. he must ensure their safety and see that all are able to complete their tasks.
he should
check the equipment of every member and satisfy himself about the condition of equipment
acquaint with trekking route and timings
know about flora and fauna and encourage members to observe plants, birds, rock formations etc
set the pace by the weakest member of the group
regulate the number of halts
keep the group together and do not allow straggling

for trekkers
keep your equipment in good condition
adhere to schedules and timings.
camp leaders are voluntary workers and do not argue with them
be prepared for a variety of food in different camps
if food is limited, accept it
do not stray away from group without notifying the leader or deputy leader. do not go away alone, take someone with you if you are going in a unfamiliar area
a trek is not a race or marathon. there are no prizes to be won. walk steadily and slowly, maintaining a steady and strong rhythm, observing nature, enjoying the beauty of mountains. if you get tired, slow down but don't stop frequently
keep toffees, lozenges handy as these will prevent thirst. don't drink water suddenly as this can lead to fainting. start early and finish significant amount of trek before noon.

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kashmir experience 4

2009-11-27T22:21:00.000-08:00

inshan to lahinwan via margan pass. margan pass is more than 11ooo feet. snow covered throughout the year. inshan is at 8000 feet so we have to climb 3000 before 10 am. as sun is up, snow melts and passes become difficult to cross.
we were made to get up at quarter to four and had to leave by quarter to five after collecting lunch and breakfast. one gentleman tarik was accompanying us. he was to take us to the top and show us on the way.
the path was on open land, no trees but climb was gentle, sun was not up so it was not very difficult. it turned cloudy by 8 am so we were made to hurry along. we ate breakfast near a stream. there were many flocks of buffaloes, goats with gujjars, their families on mules, dogs. the animals used to get scared and boys were scared of horses. dislike was mutual.
we reached a stream by 9 am which was quite wide and flowing rapidly. water was very cold. we were made to take off shoes and socks and wade through water. tarik took each one by hand and crossed the stream. poor fellow had to do it 20 times. after few crossings, his feet turned red and he had to jump up and down to restore circulation. he started screaming with pain but had to take everyone across. water was very cold. first feeling was that of extreme heat. then it felt like hundreds of ants biting, multiple needles pricking, most odd feelings.
we all paid him a rupee for his help. he did not come beyond the stream and turned back.
there was a 2 km patch of mud and rocks. it was slippery and bad for shoes. it started raining. pass was fully covered in snow which was quite deep. there were hillocks on each side, mostly black barren rocks. the peaks were covered in snow. it started to snow. we could hardly see anything. snow was quite deep and some of us were going down upto knees. there was water in some spots. then we started to pick rocks for walking. sun was not visible, it became very dark, rain, snow were falling. some horses were stumbling and gujjars where hurrying them along. wind started to blow. a most scary experience. we could not enjoy the snowfall. four of us were the last persons to cross the pass, almost everyone else had gone ahead. suddenly the fog became so dense that we could not see our own fingertips. then we walked rather slowly and held on to each others rucksack and slowly reached the other end of pass.
in this weather, a flock of birds flew over us!
eventually the snow ended and we had crossed the margan pass. the descent was rocky. fog was persisting. we could hardly see much but had to descend somehow.
we had been told that the kashmir valley could be seen from margan top but fog and snow did not allow us to see anything.
it is not possible to remember how we got down. but we did somehow. we were seeing clouds and glaciers below us!
found a plain spot around 1 pm and ate lunch. rain began again, fog was enveloping still. but kept on walking, stopping for shelter. suddenly we found a tea shop and drank several cups of tea apiece. reached camp by 230 pm. the camp is in a grassy knoll near a medium sized stream. campleader is called kukkoo. he is a amateur geologist and was happy to see us carrying salim ali book with us.
food was very good, very tasty spicy. first time after kishtawar, we got good food. i was so hungry, i finished dinner in five minutes. campfire was dull as everyone was quite tired and we were bored singing same songs. sleep was wonderful.
sleeping bags were given at lahinwan.
dawn broke at 5 am. many trees, dew on grass, birds singing, pine trees, wonderful weather.
kept lying in sleeping bag till 7. breakfast was late. margan top was in bright sunshine. today's group would have a nice time.
we left around 10 after a breakfast of halwa, puri, boiled egg and tea. it took us about an hour to reach lahinwan village when we took a bus to daxum village and reached there by 3pm.
heavy rain began at daxum and continued till evening. synthen top was not visible. we had tea with camp leader and walked to daxum village. this is a small resort and there were many tourists. had a proper tea in a regular restaurant. welcome change from goat milk tea.
food was again very good, rain had cancelled campfire. tomorrow morning we were to cross synthen pass and had to start early so slept early.
daxum to synthen via synthen pass is less difficult than crossing the margan pass and there is more snow.
first three km were in a dense pine forest. we started early as usual and had a ski instructor to guide us along the way upto synthen top.
after the forest, we had to climb over the glacier for several kilometres. the glacier surface is covered with small mounds and one can not see the top. one feels one has reached the top when you see another hump ahead. the climb is steep, snow is deep and soft, we kept on getting bogged down. but it was fun while it lasted. chikki came in very handy. cheese also helped. one needs lots of calories. the ski instructor made us walk on snow while he himself was walking on a track by the side of glacier. wise fellow. he didn't have a pack too.
we reached top by 11 am. beautiful sight. yesterday clouds had marred all view. today we could see many snow covered peaks, mountains covered with dense forests. clear skies. a most beautiful sight. everyone wanted me to take pictures. and i did take a few.
we ate lunch at top and began descent. we used the enamel plate and sat down in it and slid down wonderful time. reached synthen camp around 3pm. it rained much on the way but no trouble.
campleader is one mr desai from mumbai. he repreminded us for groupism and then suddenly it felt very wrong to have formed groups, rivalries, competition. collected few rocks, slate in synthen and sat huddled in blankets and drinking tea. campfire began late. we were lectured by a forest officer. he was very sincere and meant well but it made the affair a little dull. campfire went on till midnight when we slept outside accompanied by half a dozen dogs.

synthen to chatroo is the last stretch. it was downhill all the way in a dense pine forest, deep shade. track was good but the descent was bad on knees. apte and kulkarni lost their way and went somewhere else which lost us some time. it was a dull affair because we were all tired and anxious to be done with it. we were bored with each other's company and wished to get back to civilization. last kilometre or so was on a metalled road and finally got to chatroo and then by bus to kishtawar.
thus ended the 8th himalayan trekking program.

kashmir experience 3

2009-11-27T19:59:00.000-08:00

yordu is a place of rest for trekkers. we are at halfway mark. the camp is near river. two forest huts and few tents. camp leader is a woman and assistant is from delhi. a.d. and ambekar left for next leg of trek. breakfast was hot and tasted very good. my shoes are torn by the side and there is no cobbler. i had to stitch them myself. we went for a walk by the river. saw few water birds. village is small, about 100 houses. tea was good, tasted normal but goat milk odour was present. afternoon was siesta time. for the first time in one week, i was able to sleep in the afternoon. what a pleasure. the sun came out. bright sunshine. welcome change.

yourdu cook was complaining of headache and we passed out crocin tablets. so the cooking tent is very friendly now.
breakfast of halwa, puri, unlimited. last year, limited breakfast used to be served. boys were eating six or seven puris and 3-4 bowls of halwa. tea was limited. today's trek was to sarkandu, 11 km with little climbing. we left by 830 am and walked leisurely. track ran through dense pine forest, nothing spectacular, nothing special. we lunched at 12 and once again crossed the river. then we saw a grove of walnut trees. sarkandu came at 1 pm. sarkandu camp is in a meadow, a small glacier is close by. we had to cross a stream to get there so went there in evening and played in snow. on our way back, the stream had swelled and all footholds were under water. so had to look around and go up and downstream to find a shallow ford. campfire was cancelled as tomorrow we were to leave early.
camp leader gupta was at jai last year. we had a long chat in the evening. weather is getting colder and colder. even with 3 blankets, tents are very cold.

sarkandu was most forgettable except for the fracas at breakfast the next day. here, limited breakfast was served and delhi boys started fighting. gupta explained that there is inadequate flour but they kept on fighting and he had to relent. this delayed breakfast and departure. the trek was along the right bank of marwah river, along open plains bordered by tall cliffs further right. sparse trees along way. no pines, almonds, walnut, bhojpatra and others. we met many gujjars with their cattle and families coming in other direction. all kept on demanding headache tablets.
inshan camp is on the other side of river, which has to be crossed by a wooden bridge which sways terribly.
we could see the camp from afar but it took us nearly 45 minutes to get there. the camp is on a barren patch of land by riverside. no trees, no grass, no nothing, except bare rocks. the campleader had gone somewhere so wasn't present to welcome us. we had to cross several glaciers this trek but the path was wide and well trodden so there was little risk. it was a dull day. the main part of trek, crossing margan pass is tomorrow. we have to leave very early so everyone slept early.

kashmir experience 2

2009-11-26T18:44:00.000-08:00

sonder to sirshi, a small trek so we planned to start late. the distance on paper was 5 km. we thought we could do it in an hour.
as usual the camp was a little slack and bed tea was served at 7 am!
sonder village is beautiful. it is surrounded by rice paddies, mountains all around, pine forests. the camp leader decided to send us off without pack lunch and we left after 9am.
it was downhill initially but the road was rough, too many boulders and stones, lots of dust flying around. since we started late, it was very hot. there was little shade. this was a dull and boring affair.
we met a madman who was said to be a cook. we saw several snowcovered peaks and named them. sirshi campsite is nice. river is close and its roar can be heard all the time. food was good. mr patki is the camp leader. he is the son of national secretary of yhai. many birds in the trees. we had to bring water from a stream which was behind the camp and a little way down. climbing up with a full bucket took some effort.
we could sing many songs in the campfire and impress delhites.
it wasn't very cold at night so we slept outside.
camp leader served hot bournvita at night. how wonderful. weather turned at night. a great cloudbank rolled up and it started raining at 2 am. we had to collect blankets and rush inside. nine persons sleeping in a small room, very warm and cozy. i forgot to take shoes inside and suffered consequences the next day.
shoes were sopping wet the next day. cooks let us dry them in the kitchen in front of fire. weather was cold and hot tea was welcome.
breakfast was not served till 830 and we finally left by 1030.
we had to kill time so walked back some distance to see sonder camp which is visible from a turn.
breakfast was chhole puri and tea. pack lunch was puri and achhar.
today we had to cover 16 km. the track ran through dense pine forests, close by the banks of marwah river. there was a small aqueduct taking water somewhere, we didn't see where. the track ran by its side for few kilometres. we walked quite close to the river and spent some time sitting on the rocks. the river runs very fast, water is very muddy. there are many logs floating downstream. huge logs. there are large rocks in the riverbed. no bridges anywhere. if someone falls in water, he would directly go to heaven.
i was wondering about hillary's expedition up the ganga river which was in the news recently. it must have been some experience.
we ate lunch around 2pm in a glade. things were moving at a slow pace. no one was in a hurry. we saw a paradise flycatcher. first sight. beautiful bird. then we also saw jungle fowl, robin, shama, rock thrush etc. we were to go to hanzal for the next camp.
we had to cross a large waterfall along the way. the track was quite slippery. with rucksack on back, it was quite difficult but we had to manage.
we met a sardar coming back and he scared us by telling that hanzal is 8more miles and it would take us at least 3 more hours.
we almost ran to catch the leading group. had a cup of tea and again walked fast. the track now ran through a dense forest, it was almost dark. it was like walking through a tunnel. dark clouds, low lying. we had to cross few frozen nullahs. the snow was quite dirty so could not play much. weather was such that we were afraid of rains. a.d was walking quite slow so we made him walk in front and all followed behind. it is not safe to let someone lag behind.
we reached camp by 630 pm and it started raining. we just reached there in time. weather became very cold. after two or three cups of tea, some warmth seeped in.
camp leader at hanzal is one dr gautam jaswant. when he learnt that we were medical students, he ordered cooks to make alu paneer and ordered them to give us royal treatment, whatever it meant.
anyway, a good gesture.
dinner had to be eaten in pouring rain. campfire was cancelled.

hanzal camp was covered in clouds and fog next morning. rain had stopped some time in the night. i could hear many birds but couldn't see one. beautiful weather, a little chill, no sun. ideal for trekking. tea was very good. actually when weather is cold, any hot water with little sugar is going to taste very good. one can drink litres of tea here.
there was some time before we were to leave so scrubbed the place and lunch box. i am going to be an expert pot scrubber by the time i finish the trek.
breakfast of halwa and puri. halwa was probably ata and gur mixed and cooked. but it was hot, weather was cold, we were very hungry and it was very good.
gautam passed out toffees.
today we had to walk 16km to yordu. it was considered an easy stretch. as usual, we started late. the track ran along river, no forks, no diversions. straight to the next camp. we crossed few small streaks over log bridges. forest was medium, not very dense. weather continued to be cloudy. then ambekar, a.d. and medsingh went ahead. five of us were walking little slowly. saw the goldenbacked woodpecker. beautiful bird. here in cold weather, birds are more colorful.
suddenly we came near a stream and there was a big crowd there. a medium size stream with log bridge. few gujjars, a.d. and medsingh. a.d. was soaked to skin, he had taken off some of his clothes.
a.d. was crossing the stream when the log turned and he fell in water. immediately a gujjar jumped in the stream and caught him and a log. others took them out. it must have taken few seconds. both were soaked. shivering. a fire was lit and they were made to sit near it. a.d. was lucky not to have gone in the marwah river, otherwise it would have been the end. he lost his glasses, broke his wrist, lost his camera. he changed clothes, gave some money to the gujjar and we left the spot.
then we had to cross a quicksand patch. it was not a quicksand but a patch of mud. we had been warned about it so crossed it carefully, holding hands and all going together.
it started to rain, we had to cross more streams. at one point, we had to jump across but a gentleman gujjar was standing there to help us.
a.d. lost his slippers in the next stream.
then we crossed another stream of mud. this mud patch was moving down the hill like a river. some trees were growing in the mud stream and they too were moving downhill.
we were able to see the camp in some distance so decided to eat in the camp. the track now ran in dense pine forest and we crossed few very minor streams. we reached camp around 4 pm. the village cemetery is on the way. some lily like flower is planted over graves. we are not supposed to pluck the flowers.
village is quite small, about 300 people.
villages are peculiar. most have a shop or two which sell everything from chappals, lanterns, clothes, groceries, biscuits.
food is good, water is scarce. campleader appears little strict. so what.
a.d. and ambekar have decided to go ahead with the first group. we have a day's holiday tomorrow. a.d.'s wrist is broken and he wishes to get it treated as soon as possible.
number of blankets is decreasing as we are climbing.

kashmir experience

2009-11-19T06:45:00.000-08:00

in the summer of 1978, we went for a trek in the pir panjal mountains in the kashmir valley. the trek began from kishtawar and passed through the margan pass and synthen pass and returned to kishtawar after 12 days.
this was a slightly more difficult trek than the one we had done in 1977, the one from Bhadarawah to Padri pass and back to Bhadarawah.
this time our group was larger, there were 10 of us from aurangabad. myself, sunil apte, darshane, sanjay muley, ambekar, medsingh, sanjay kulkarni and his brother, raju joshi, anil khot, and two more.
the journey from aurangabad to delhi was eventful.
this time we did not have reservation for delhi and had to travel by general dabba.
we reached manmad in evening and prepared to board punjab mail which used to arrive at 10 pm. the train arrived on time. being summer, it was crowded. some of us could get in the last dabba, while me, sanjay and some others had to run all the way to the first dabba when some others got in through the window.
the train left and me and sanjay muley were left on manmad station with several bags.
abhay darshane and sanjay ambekar had gone via mumbai/ western railway.
me and sanjay muley had to spend the night at manmad station waiting room.
we paid a cooly some money to help get in amritsar express and could get in the train as it arrived the next morning at 4 am.
we were able to secure a berth and get in all the bags.
the day and night passed somehow and we reached delhi the next morning. others had reached the previous night. punjab mail is a faster train with fewer stops.
i don't remember what i did the whole day, what i ate, what i drank but the journey was most uncomfortable.
raju joshi and others had arrived to welcome us and took us to maharashtra samaj, a dharamshala near old delhi station and approachable by rikshaw from new delhi station. this was an interesting place. two or three big halls with durrees, people had kept their bags in the hall and were sitting and talking. the rent was rs.3 per day. there were few toilets and bathrooms. no hot water. no food. but very cheap.
we had a bath and changed, went to new delhi station to book return tickets but could not get any. went to connought place for window shopping. ate something somewhere and were back by afternoon to catch the evening train to jammu.
reached n delhi station and all of us were able to get in the train. it was very crowded as usual and we could get only seats in the general dabba.
even after nearly 30 years i shudder at the experience.
reached jammu the next morning after a harrowing night. took the bus for kishtawar. the journey went as usual, from udhampur, the weather changed for the better.
ate lunch at batote.
batote is a queer place. about 2km stretch of the highway has only dhabas. each will have a bus or two and people would be sitting and eating.
vaishno dhabas serve vegetarian food. others serve meat also.
food is usually tasty, hot and spicy.
we met two boys from delhi who were going to kishtawar. snobbish. tried to act aloof.
reached kishtawar in the evening. weather was very cold, camp was in same place. larger.
camp was a little disorganized. harish saxena is the director. blankets were lying around. we were expected to pick up from the tent without supervision.
acclimatization walk was along a track, between fields swaying in wind to a stream where we had bath and could wash some clothes. usual breakfast of bread and jam.
rockclimbing training was very dull. we had had some experience. no sherpas this year. little rappelling. the instructor was a bore.
we were to leave next morning for ekhala via palmar.
the journey from kishtawar to palmar was by bus. the bus was crowded, it was dusty, hot, stuffy and a big bore. however, it had to be endured.
we got down at palmar and started walking. the track was not very difficult but then a steep climb along a zigzag path began. there were no trees, no shade. we were sweating. i tore my pants. after the steep climb, the track entered a forest and then it was comfortable. we stopped for lunch and tea. there are many tea stalls along way. most serve tea made of goat milk, not very good but it has to do. no food is available anywhere.
next part of the trek was along a steep cliff, at least a thousand feet above the foaming river. scary sight. we had to walk very carefully at some spots but it was fun.
camp was reached at 3 pm. camp leader served us several cups of hot tea which took away all fatigue. one mr khatri is the camp leader. he told us that garge has gone to brahma base.
then we got talking with some locals who told us some interesting customs.
they don't consume or sell cow's milk from september to march. during this period, they use goat milk. but they can use buttermilk or ghee.
before a widow is able to remarry, she marries a tree. if the tree bears fruit, then she is considered fit to remarry.
all marriages are arranged and if the couple marries against wish of the family, they are outcasts.
branches of a pinelike tree are used as torches at night, also during diwali.
a type of tuber is used for washing clothes.

ekhala is a hindu village, population was about 200. most hindus are brahmins or pandits.
the camp is in a forest hut and tents. it is surrounded by pine trees, near marwah river. there are tall cliffs, snowy peaks all around. grand view. too many flies.
back, shoulders, knees, thighs, everything is hurting. this is the first day.
next day, it was announced that we have to stay here as provisions have not reached next camps. we hung about doing nothing after cleaning the camp and tents. then we saw a mule train come from palmar and go towards higher camps.
we went for a walk in the forest. pine needles formed a deep carpet and made it very slippery to walk. lot of pine cones lying around, also pine gum. many varieties of ferns. coming down, my both hands were occupied in carrying ferns and other specimen. it was a slide.
lunch was khichadi and potato curry. it was hot, spicy and after walking for some hours, everything tastes very good. soup was watered down.
there was nothing to do after lunch. we walked to a stream and some of us had a bath. i declined the privilege.
then tea and some of us decided to visit a logging camp somewhere up the hills. we kept walking for a hour and half and reached nowhere. had to come back without seeing anything.
campfire was a dull affair, locals sang some songs which we did not understand but had to appreciate.
a trekker from brahma base returned in evening. he talked about accident somewhere which had held up the trek. he gave me a sample of bhojpatra. he had come directly from nantnala and was planning to go to kishtawar tomorrow. some stamina.
next morning dawned dull because there was nothing to do. we still did not know whether we were to stay or go. so had breakfast and decided to take a bath.
water was extremely cold. it was almost impossible to breathe. but then it was fun.
lunched at 12 and then suddenly two groups arrived, one from palmar and other from sonder. so the brahma group left and we too had a quick lunch and left camp at 1 pm. what an odd time.
we had to cover 18 km to reach sonder. we walked quite fast and rested every hour for 5 minutes. the track was not steep nor difficult so we could walk fast.
we reached sonder by 6 pm.
we had some goat mik tea anc shankarpale on the way.
the camp leader from sonder, a girl had walked some distance to greet us. a good way to welcome trekkers. there was some snow on the way, our first snow. last year when we had crossed padri pass, we hadn't encountered much snow. it was a small glacier under which ice cold water was flowing. from top sun was beating down. this is crazy. heat and sweating is tremendous and weather is so cold. afterwards, the track ran through pine woods and it was descent all the way.
the campleader had brought some chikki for us.
we say many birds on the way, robin, blackbird and others. it took us nearly half an hour more after meeting the camp leader to reach camp. we had thought it would take few minutes. we could see the camp from some distance and it appeared very close but the track was winding along mountain side and took some time.
this was very tiring and i caught a nap.
we had some tea and biscuits in the camp.
the campsite is beautiful as usual. water is rather away. there is no banner on the camp. the other camp leader is a idiot. he didn't turn up for the campfire. dinner was served at 9 pm. it gets dark quite early and then it is difficult to move around in the camp. it is best if dinner is over by 7 pm, campfire by 8 pm and lights can be out. dawn breaks at 5 am so we can actually start by 6 am. this will save us much trouble. yhai is stuck in its ways and won't change.

sleeping in milan airport

2009-11-16T22:16:00.000-08:00

during my second trip to italy, on the last day, i decided to skip hotel stay in milan and slept in the airport.
on return from genoa, i bought some bread, cheese, jam at milan station and took the bus to airport. this saved hotel charges, cloak room charges.
on reaching the airport, it was possible to get in without any questioning, checking at the gates.
found a convenient bench near the toilets and ate dinner. there was another girl, indian looking sleeping on another bench. there are no benches actually, only chairs but there are strategically placed corner chairs on which one can sleep.
ate dinner and then walked about for a while. it was difficult lugging large bags but couldn't sit in a place for long.
slept at 11 pm
several airline staff walking about.
pairs of policemen also but no one bothered.
the other girl was also sleeping somewhere.
got up in the morning and went to toilet. toilets are very large, one can push the bag in the toilet while one is doing business.
washed and brushed teeth.
ate leftover bread and jam.
had a cup of coffee and went out for a walk.
weather cool.
walked for a while and entered airport again and checked in.
this time, it was a smooth affair, not like last time when they managed to cancel my booking.
then again kill time. do some duty free shopping and back to waiting.
flight was delayed by a hour. the bus took us to the plane and then brought us back. how nice!

so if one wishes one can spend a night at the airport and save at least 50-60 euros. except for a little discomfort, there is nothing against it.

italy travel 12

2009-11-16T22:06:00.000-08:00

weather is mild, there is little dirt, fewer dresses can be carried.
carry lots of toffee, chocolates as these are very expensive in italy.
carry more snacks from haldiram.
thalipeeth and gakar will last for a week and provide breakfast. save lots of euros too.
polythene bags for laundry.
swiss knife.
rubber bands.
extra shoelaces, extra spectacles.
i broke my glasses the first day and had to do without them for two weeks as replacement was very expensive.
basic medicines.
safety pins, paper clips.
empty bag for extra shopping.
sewing kit
folding umbrella
passport/document carrier- wear it around your neck at all times. there are many pickpockets but few muggers. so if you carry your passport, money on the body, you are safe.
credit/debit card
money belt
coin purse
paper soap
paper napkins
deo
nailcutter
sunglasses
extra batteries and films
alarm clock/mobile
shoes, socks, talcum powder.

italy travel and people

2009-11-16T21:31:00.000-08:00

italians are handsome people generally roman noses, strong features. blondes and brunettes as common as dark hairs. tall. not obese but most are stocky. fair skin. fair eyes are quite common, i thought this would be uncommon along the mediterranean.
men dressed in trousers and shirts. women wear frocks, skirts, trouser suits. younger girls outlandishly dressed. trousers very low. natal cleft seen. panties visible quite often. public display of affection very common. low cut revealing tops. more women smoke than men. people talk a lot. wave hands about.
italian pronounciation is different from english. it is better to write what you want and show it to someone for directions.
most people in genoa very friendly. the man in train help desk directed to bus 17, then another gentleman showed the correct bus stop. another lady on the bus showed the stop and pointed the hostel. same experience in rome and florence too.
but shopkeepers and others in rome reluctant to give directions. too many tourists.
hotels very expensive. dormitory in rome costs 40 euro, nearly rs.2000. food very good if one likes cheese and sausage.
one has to walk a lot to see anything.
public transport excellent.
i have to thank gaslini internationsl for this opportunity to travel to italy and fulfil my ambition.

italy travel 10

2009-11-16T20:50:00.000-08:00

wedding anniversary today. called home. checked out of hotel and took a bus to piazza de liberty near station. sat in the square and ate breakfast of bread, jam cheese. tried to feed one pigeon when a thousand pigeons landed shedding feathers, raining dust and annying the dustman who had just vaccumed it.
went to san lorenzo and medici chapels. another church service going on. two priests sitting and muttering something in latin. cancelled visiting bargello. bought a belt in a market near the medici chapels. bag has become quite heavy now. went to station when found that all trains were delayed. had to sit and wait till 125pm.
no waiting room in the station, had to sit on the platform.
florence station is quite busy and crowded. even trains dont sound horns while entering or leaving. so quiet. even cars rarely sound horns. last two weeks, i have heard the horn only once.
train to venice was delayed and came on another platform.
had to eat some lunch in the station. i am on a starvation diet. must have lost some weight.
train was crowded but we managed to get two seats.
whole of country is settled. throughout the journey, one sees farms, houses, towns, factories. no patches of open, barren land. however, no people could be seen.
florence to bologna, then padova and venice.
got down at venezia mestre and tried to find a hotel. it was a mistake, no hotels available at mestre. saw the orient express arrive from venice and leave. that made the stop in mestre worthwhile. beautiful deep blue color, oldish looking.
got into another train and reached venice. found a hotel at last.
venice is beautiful, well all of italy is beautiful. yellow /brown houses, tiled roofs, NO CARS. launches, gondolas chugging along.
hotel for one night, and we are happy. left bags and went walking. it was already dark. narrow lanes, people walking. pavement cafes. serenaders. usual italian scene. no wonder people love venice. silent city.
back to hotel and slept early.
got up very early and saw boats moving about with goods, vegetables and other stuff. finished bath, breakfast of bread and jam and left. took vaporetto to st marks. church was closed so walked about. boat goes along the grand canal but can't see much. everyone travels by boat, even schoolchildren going to school. conductor was a young girl who was announcing stops in a nice singsong voice. she had a argument with a passenger and came on top.
san marco, mosaiacs is too good. many tourists. went in the cathedral, rather dull, dark, oppressive. mostly wooden. not very impressed.
returned by another boat which came from open sea. saw other churches and monuments; st maria and others.
saw a cruise ship up close.
one will need at least a week for every city in italy. a day is too little but will have to do.
last minute shopping and returned to hotel. checked out and walked to station. settled accounts with clt. bought a glass dolphin, two paperweights, two glass pendants in the station shop. train arrived on time. it had number, name and so on. one eurostar was standing on another platform so got in to take a look. very spacious. large.
all trains except locals are airconditioned. reservations can be made but is not essential. at the entrance, a board marks seats which are reserved so one can check and occupy seats. no adjustments are made. if you don't have a seat, you sit in the corridor. three or six seats in each compartment. main doors close automatically. trains hardly make any noise. travel very fast. good acceleration and deceleration. produces fullness in ears while passing through tunnels.
though trains travel fast, it doesn't feel like it. we covered nearly 400 km in 3 hours.
tickets are checked on train, about once every hour. before every station, announcement in italian, sometimes in english. trains stop for very short time at stations. sometimes vendors of food and drink push a trolley. trashbins in compartments and people use them. no platform tickets. tickets not checked at station exit.
saw marble mines at brescia and carrara. entire mountain seems to be made of marble.
train stopped at padova, vicenza, verona, breschia and finally milano. train went along shores of lake garda before reaching milan.
got a hotel nearby. checked station layout, baggage room, airport bus stop etc. ate in macdonalds. bought bus ticket and all ready to go home.
hotel is small and unobtrusive. walked about in evening. wtched tv, threw away lot of stuff like tablets, mug and other useless material. got up at five, finished routine and went to station. cloackroom open. got the bag and got into bus. reached airport at 7 am. alitalia wasnt checking in so had to wait till 745.
at checkin, the lady said there was no booking. so had to run to ticket counter and get the ticket reissued. then back to checkin. bag weighed 28 kg but clerk did not mind. security was chaotic. too much metal, chain, belt, phone, keys, coins, everything had to be taken out and put back. ate breakfast, very bad pizza, worst of the lot.
then went to dutyfree shopping and got some chocolates. got rid of most cash.
waiting for flight to be announced was dull. not enough seats, room crowded. full of indians.
before boarding, clerk asked for ticket, in addition to boarding pass. somehow found it. what a nuisance. airline staff rather rude. one rev yesudas was in next seat.
weather cloudy so couldn't see anything. plane flew over mediterranean, lebanon, saudi arabia, arabian sea and finally mumbai.
cabin crew of alitalia barely polite. did not answer bells. one had to demand water and insist on it. typical white attitude but so different from italian people in italy.
reached mumbai at 1030 pm, sultry weather. long queues for immigration and customs. ganesh waiting with mamashri. back to andheri. and to sleep.
took tapovan express from dadar, met sawant who saw the bag and labels but overcome his curiosity.
breakfast on train was terrible.
loud speech, cross faces, dirt, noise. its so different, but i am home.
sanjeevani and children waiting on station.
govind patel was leaving aurangabad for delhi.

italy travel 9

2009-11-15T22:51:00.000-08:00

got up early and took a bus to brignole station and a train for pisa.
took a map from tourist office, had to pay for it. surprise!
took a bus to the tower. one indian looking person was in the bus and looking at us all the time. when we got down at the last stop, he introduced himself and told that he was from pakistan, born in nagpur, working in pisa for several years now. lives in florence! come by train every day to pisa. works as waiter in a restaurant near the tower. asked us to come there.
saw the tower, cathedral. many tourists. crowds, all taking pictures, funny videos. shooting for a film with sherlock holmes character in progress. clt is rather slow on the uptake. the monuments have appeared so often in documentaries, books that looking at them is anticlimactic. but still worth a visit. standing in the cathedral where galileo first thought of the principles of pendulum gives one a thrill.
climbing the tower is expensive. declined.
souvenir shopping, breakfast in paki's hotel and back to station. collected bags and to florence by another train.
trains run on time. no name on train, no number. nothing written on coaches. but no bustle on station. announcement in english and italian. we had to ask again and again just to make sure we get in the right train.
all trains have different coaches, first, second, sleeper, one for cycles. all coaches shown on a diagram which is on the platform so one can plan where to get in.
reservations are available but this is not the busy season so are not necessary.
tickets are checked on the train and never at the exit.
reached florence in afternoon. took some time booking a hotel but finally got one. hostel sette santi. took a bus to hotel. buses allow baggage. how useful. checked in the hostel, then walked to busstop and then bus to pizzale michalengelo. this is on top of a hill from where one can see the skyline of florence, the duomo etc. florence very crowded with tourists. the hill has a replica of david. went to santa croce but it was closed. walked about. found a pizzeria and ate very bad pizza. poor service.
hotels are most unobtrusive. a very small brass plate outside the hotel. so difficult to search.
sette santi is about 3 km from station. connected by bus. a hostel, now converted to hotel. we had a room with toilet but no bath. breakfast was available, but we bought some bread and cheese.

power failure in whole italy in the night. when got up at 6, no electricity in the hotel. no running water. no lights in the city. so like back home. night porter was helpful but couldn't do anything. found a toilet with running water and did business. hotel very quiet despite power failure. no shouts, no ruckus.
no bath so used plenty deodorant and went to duomo.
got down at san marco which was closed. walked to duomo which was also closed. went to uffizzi which also closed. no idea when it will open. so walked to santa croce and sat in the sunday service. then saw the tombs of galileo, dante, michalangelo.
during the mass, when the priest announced that christ has risen, several couples kissed, others shook hands. how curious.
gave a small coin as donation.
brought back a copy of service.
this is the third sunday service i am attending, first in milan duomo, second in vatican and this in santa croce.
walked about piazza della signorita and saw the statue of perseus killing medusa by cellini. touched it. got my picture near it.
having read about it many years ago, i was moved to see it.
two or three americal women were discussing the features of the statue and i lectured them on it.
a cycle race in progress in the heart of florence. very small children, even two and three year olds probably. cycling lustily. parents cheering. very cute.
uffizzi had opened and today admission was free.
bought some lasagna from a restaurant nearby and ate outside uffizzi, standing in line waiting for the gallery to open.
at last, uffizzi opened.
enormous gallery, several large halls, full of paintings. original pencil sketches by leonardo da vinci and michalengelo. botticelli, raphael, titian. you name the artist, it is there. fantastic. but becomes overpowering after a while. one stops noticing things. bought a book in the souvenir shop and out by 530 pm. walked to duomo, then to station, took a bus to hostel.
decided to go out for dinner, had to walk some distance to a pizzeria. american gp was in progress and people busy watching.
table mats were the menu so easy to order. ate a very good pizza and walked back to hotel.
anyone wishes to see italy should have a strong heart and good knees. best time is before 35yrs. must prepare by walking several miles every day. walking museums, climbing long flights of stairs is a pain. not for the elderly.
checked the SITA brochure on italy. they don't show any museums in rome or florence. what is the point?
the trip from pizzeria to hotel was along a dark street. not much pedestrian traffic. few cars going. quiet.
not scared though.

italy travel 8

2009-11-15T21:58:00.000-08:00

evening went to nervi for a walk. many people jogging, young, middleaged and old. in genoa, just moving around gives one much exercise. the city is so hilly, ups and downs all the while. i haven't seen a really fat person in last 10 days. mediterranean diet and walking. we are picking up some italian. ate a very nice pizza, must have been at least 36" diameter. a small fair in the park opposite brignole station. stalls selling clothes, curios. snacks, chocolates. live music and dancing. how curious.
went to portofino after catching a train from brignole to santa margharita. then by bus to porto fino. santa margharita is a small seaside town with many hotels, tourists. mostly staying for relaxation. road from santa margharita to portofino is hilly, tortuous, narrow. but traffic is disciplined.
portofino another small seaside town. hotels, houses. saw the place where guy de maupassant lived and died.
one old man selling miniature cars.
back to bus stop and to santa margharita. met few englishmen and newzealanders. nice to hear english after many days. they too were surprised to see us and hear us.
talked to the administrative director of hospital. clinical records not computerized while administrative records are.
all treatment paid for by government. hospital conducts treatment and send discharge summary to health ministry which reimburses.
cpt codes, icd 10, drg used.
thomas had to translate all along but a good and interesting discussion.
went to see palazzo reale which was closed. genoa university is close by. very crowded. bought a hand bag. to XXth settembre. perfume and a book on mediterraneal cooking.
another book of historical photographs.
back to hostel, change and walk to gaslini hospital along via carrara. bus to villa gaslini.
old villa, large grounds fancy furniture. paintings, sculptures, grand piano, chandeliors and so on. dinner semiformal. over in one hour. many hospital dignitaries present.
most of the crowd is young and is out to have a good time. i find myself out of place and not able to join in the fun.
with italian doctors, conversation flagged after few sentences.
battle on!
on last working day, fewer faces. two croatians have gone. also one romanian. and the serb. dr cama spoke on neurosurgery but no one was interested. half the people slept.
shoaib and zsolt left after lunch; also michelle. other croatians disappeared. dan sabou and friend left after lunch. at 545 it was over. just a formal handshake and promise to keep in touch. exchange cards and emails. took last few pictures.
off to brignole for final shopping in the fair. dresses, chocolates. sandwich and back to hostel. final packing. brignole has become so familiar.
genova is a quiet city. no tourists no one running around with maps, no crowds except in city centre. bustle but only local. few speak english but most ready to help. salesstaff friendly. contast from rome. if one wants to relax, he should come to santa margharita. genoa is green, very green. all houses have flowers. all roads are shaded. traffic moves fast. good public transport. good trains.
i love genoa.

italy travel 7

2009-11-13T04:47:00.000-08:00

afternoon session over early so went to de ferrari and then walked to gallerie spinola. saw st luke's church on the way. gallerie not very good. stuck in middle of nowhere.
then along palazzi della meridiana to palazzo rossa. good collection of paintings, artefacts. all ceilings painted. it had a durer but the painting was being restored so could not see. several english speaking workers. showed us around. not too many people.
a gentleman took us to a window in the gallery and showed the skyline of genoa and prominent landmarks, buildings.
he told us to take the lift and go to the park nearby and see the funicular railway too. without this advice, we would certainly have missed a notable feature of genoa.
crossed the road, via garibaldi and took a lift to the gallery. bus pass is also valid for the lift. the park has a restaurant and seems to be a walking area for children, families with dogs. a man walked six of his dogs. the dogs are friendly though. no fights.
had coffee and a girl heard us talking english and chatted about local spots, places to see and so on.
then took the funicular railway to st. anna and corsa magenta. the railway is a single carriage, works on electricity, has few seats and standing room. one driver controls the ascent and descent. the rise is very steep. went up, got out, found a restaurant. ate risotto and something else. good food. came back by the same train, to brignole, booked a ticket for rome on friday night and back to hostel.
while booking ticket, i managed to lose the credit card in my shirt. when reached home, did not find it in the pouch and imagined that i left it at the railway counter. so took a taxi (7 euro) to station and talked to the clerk. he did not understand what was going on and was greatly disturbed. however, suddenly found the card nestling inside the shirt all the time. so back to hostel and sleep.

next day was orthopedics, again a dull affair.
afternoon went to the hospital, saw the casualty, icu, emergency room.
icu-surgical scrubs for staff, cap, no mask. visitors wear a paper gown and cap. nurses walking around with mask tapes hanging loose. some jewelery worn. many chronically sick babies. one 40 days on ventilator and tpn. left hospial. went to via argentina and saw a vegetable and fruit market.
dinner in a restaurant- sphagetti and back to hostel.
packed sack and left hostel at 10 pm.
reached station in 30 minutes. sat around. train at 1248. plenty of time to kill. very few people in the station. janitors cleaning. little traffic. scary scene. silent. walked about and tried to feel confident.
had to ask several times whether the train was right one.
trains stop for a very short time.
train arrived but on a different platform so had to rush there. got in. first bogie full. got a seat in the next one. six seats in one compartment. no sleeper. three persons kept jabbering for quite some time. a gentleman tried to talk which i could not understand at all. so gestured and gesticulated!
italians talk so much.
could not see a thing outside.
the train continues to naples so had to ask people to tell me when it reaches rome.
reached rome early morning. the train does not go to roma termini but to roma ostiens. the gentleman who was trying to talk in italian asked me to get down at the station and then take a metro to the coliseum. he also showed the dome of st peters which can be seen from the train as it passes through rome.
so reached rome at last. bought day pass and took metro to coliseum. station was barely open. coffee stall just opening. bought a coffee for 1 euro. and walked out. coliseum is just across the station. what a beautiful sight. floodlit. silent. no one around. people waiting at bus stops. shopkeepers setting up and opening their stalls. coliseum is grand. crossed the road and walked about. coliseum opens at 9 am so had to kill 3 hours. sat in a park and age moong dal and had another coffee. walked to forum where a great many cats were playing. saw a woman arrive in a car and feed cats.
area opposite the coliseum has these various gates. this was open so looked around.
a sweeper truck arrived, driven by a woman.
even the garbage collector looks graceful.
coliseum finally opened. lot of tourists, many chinese. walls are at least 10 feet thick. inside is nothing. but the arena is huge. wonderful sight. steps very tall. took pictures with gladiators. he asked for money and was disappointed to receive 50 c.
walked through forum and picked up a stone as memento. to capitoline museum and campidoglio. saw the statue of marcus aurelius and his column.
walked to foutain trevi and threw a coin.
hundreds of tourists walking about.
santa maria maggiore church but all churches look the same after a while. nothing could register.
went to roma termini which is near, booked return ticket and got a hotel. went to hotel, actually a dormitory. changed and went to borghese gallery. had to walk across borghese park. saw bernini sculptures.
this has been a high point of my life.
stupid hotel clerk made me take a metro to spagna and walk all the way to the museum when i could have just walked to the museum from the hotel itself. a very roundabout way.
met a sardar in the metro on way back. he was happy to talk and asked me whether i had papers. he is a illegal visitor but now is able to get a work permit. works as a carpenter. how funny. warned me about pickpockets, said everyone in italy is a 'chor'. how offensive.
bought some bread, cheese and jam in a supermarket for tomorrow.
returned to hotel and slept. three americans and a chinese girl in the dormitory. they returned some time at night and left early. chinese girl got up and left.
had a quick bath, checked out and walked to roma termini metro station. metro to ottaviano station which is close to st peter's colonnade.
met a italian family which was coming to rome for the first time and was able to actually show them the way.
how interesting.
reached st peter's quite early. few visitors. entered the basilica. very impressive. many statures, chapels, monuments.
saw the pieta.
services going on everywhere. people, priests moving about. sat for the main service, this being sunday, many people attending. moving affair.
left after some time.
sat outside and ate bread and cheese.
walked to castle.
vatican museum is closed today.
castle is small but knowing the history and how cellini fought there, the visit becomes interesting.
took a bus to via argentina and went to the pantheon. saw raphael's tomb and laid a flower there.
suddenly got tired of rome.
rome will require several years. which is out of question. so why bother to see it in two days?
went to termini. ate some cheese and bananas. train at 1345 and reached genoa at 7 pm.
dinner. a fair in the park opposite brignole station. bought some perfume and candy. back to hostel.
CLT went to milan and saw the last supper and did not like it.

italy travel 6

2009-11-10T23:46:00.000-08:00

presentations are quite uninteresting. non academic activities are fun.
went with clt to aquarium. got a bus to piazza de ferrari and from there to aquarium.
aquarium was not crowded. large building, many fishes, did not know names of many. huge dolphin tank. a dude was swimming inside with scuba apparatus. two dolphins in the tank. these are large creatures, as big as a man or even larger.
walked along the jetty and regatta. beautiful yachts. saw the lighthouse in distance.
went to a shopping centre and bought a starfish.
shopping is way too expensive. everything costs at least 5 euro.
also got a silver pendant in the aquarium.
went to columbus gate and house near brignole. the city is fantastic. cobbled streets, narrow lanes. small pizzerias tucked in here and there. locals eating out. strolling musicians. the woman in pizzeria very friendly, obviously pregnant and proud of it. served us pizza and talked some english.

italy travel 5

2009-11-10T23:33:00.000-08:00

this morning, ate breakfast with clt in hostel and both of us walked to badia. morning session was academically dull. took pictures in tea break. lunch was salmon and lasagna, yoghurt and marmalade baby carrots, chavali shenga. afternoon, we all walked down to the sea. narrow lanes between houses, steep slope and steps. people walking about. houses with many flowering plants, pots, flags flying.
got down to the main road and walked for a while then took a bus to gaslini hospital and went to the surgical ward.
no crowds outside hospital, no one sitting on pavement. no food stalls. no security guards shooing people out. what a change.
one security cabin to allow cars to enter premises.
gaslini hospital is spread out over a large area, separage buildings for casualty, maternity, surgical ward, medical ward and so on. all connected by tunnels or covered passages. children's ward beautifully decorated. all walls painted with children's paintings. framed pictures, plants, mobiles. rooms clean. nurses wearing white smocks and pants. doctors in long sleeved aprons. all literature in italian so did not pick up anything. all patients had parents with them. rooming in is normal. narrow corridor with small rooms off it. no wards.
took a bus to nervi, shopping area of genoa.
narrow streets, shops, people walking about shopping. beautiful houses, trees. shopkeepers friendly. few spoke english. bought a dress for ketaki and shirt for suparna from a chinese couple selling clothes. how interesting.
found a supermarket and bought some bread, jam for breakfast, pasta packets.
cheeseshop with huge cheeses. big sausages. could not get a tin of sausages. bought some lipstick and perfume in a store. the saleswoman very friendly, giftwrapped both very nicely. handed us two small perfume samples. spoke presentable english.
people are courteous. only two of us indians in the market obviously foreigners, with backpacks but no one seemed suspicious or gave second looks.
found a pizzeria for dinner and bus 17 back to hostel.

italy travel_4

2009-11-08T18:28:00.000-08:00

15th september dawned clear and fine in genoa at the salesiano hostel. after yesterday's tiring trips, sleep was most welcome.
the room is smallish, has a radiator, large window which i had to open as the night became very warm. there is no fan or AC. attached toilet/bath with shower cubicle. nice and clean. 10 rooms in the wing. all were closed. soundproof. impossible to know if someone is murdered. well, no one is going to be murdered, this is certain.
yesterday, the caretaker had showed the vending machine and how to operate it. in morning, i put in some coins and the key but the damn thing did not work and i lost a euro or two. anyway. met a resident from bari who is attending the course. he conveyed the message that breakfast will not be served in the hostel and we have to fend for ourselves. he paid some money as reimbursement towards breakfast. one can't eat money. but will have to find something.
ate some laddoos and parathas which sanjeevani had packed for breakfast. no tea. italians don't drink tea. they like coffee. no coffee machine in the hostel.
no laundry, no mess or canteen.
the hostel is situated on a quiet road, on a hilly part with a view of the sea. the sea is brilliantly blue. lovery sight. we could see some ships/boats coming towards genoa. some powerboats throwing wakes.
yesterday when i reached hostel, i found a big sheaf of papers, one printed sheet with instructions on how to go to the conference venue, if i decide to walk or take a bus or whatever.
interesting, the extent to which organizations go. how different from our great country where things are usually left to happen by themselves.
so got hold of the paper, and walked down to badia beneditta. little traffic on road, children getting ready for school. a hotel on the way and a petrol pump. self service. one pays for the petrol and pumps it oneself.
two persons were standing near the entrance. there is a small church across the road from the badia, a newspaper shop and houses. a nice residential area. a post office on the main road, a fruit shop and several newspaper and book shops.
the badia is a large old building, stucco, romanesque architecture, in a large park with many tall trees, fountains, lawns. some fruit trees with strange fruits. statuary.
walked to the hall and found one dr thakral from oman; originally from bikaner, india. also met one dr shoaib from hungary, originally from pakistan. we hit off famously. more europeans than asians. slowly the group assembled. about 40. 12-15 russians; 6-8 yugoslav/croatians; three romanian, one lituania, two albania, four italian, one from tunisia, four indians, a couple form lebanon, one woman from israel, one from iraq and some more.
no one from a developed country like france, germany. as expected.
prof jasonni arrived and introduced himself.
a middleaged gentleman, typical roman features, soft spoken, typical professor.
the two guys seem to be bent on asking a question on every presentation. russians are mostly quiet. jasonni spoke quite well but italian accent comes quite strong. only to be expected.
arrangements are good. small hall, permanently fixed projector in ceiling. computer station in corner, wooden chairs with writing pad, two screens, whiteboard with marker. one person on duty for setting up speakers and so on.
one mr thomas wiley, american is the co-ordinator. he is responsible for the arrangements.
maria catarina cogorno is the secretary who sits in the reception and helps participants.
we all got two weeks bus passes which allow unlimited travel on all buses and local trains in genoa. how nice!
lunch was served rice, chicken, salad, bad coffee. little sugar, very strong, quantity very small. afternoon sessions by prof martuciello, dr biassio and dr bufa. biassio is a radiologist, speaks average english. talked on antenatal diagnosis and management.
evening went with clt to piazza de ferrari, centre of old genoa. saw ducal palace, theatre carlo fellici, church of st ambrogio, monument garibaldi. ponte monumentale. walked along via XX settembre towards brignose station and ate pizza in a pizzeria opposite brignole. these seem to be family affairs. two brothers were running the show, a young girl was serving. most customers seemed to be railway employees. took some pictures. took bus to hostel.
in general, first day passed well and we had a good look at old genoa, ate italian food with italians, and not in some tourist restaurant.
there aren't any tourists in genoa for that matter.

italy travel_3

2009-11-07T20:59:00.000-08:00

mumbai to milan trip was uneventful. food was good by airline standards. but couldn't sleep much.
reached malpensa in morning.
customs and immigration were perfunctory.
took a bus to mialano centrale station. road is probably an express highway. malpensa airport, typical two tired airport. snow covered mountains to north. weather quite cold. not much security about. few people in the bus. mostly indians. though the plane carried about 250, 90% indians.
met one mr valentine who works for thailand government in germany and hails from india. teamed up with him to see milan and monza.
little traffic on the road. road passed through agricultural land, some industry, warehouses. being sunday, few people about. not many flats but individual houses. all houses have tiled roofs.
bought day pass for milan local transport, and ticket for genoa. kept bag in cloack room. one stupid policeman suddenly decided to be aggressive and checked the bag. said something about the swiss knife. had to ignore as could not understand a word.
went to tourist counter and got maps of milan.
ate a burger and milkshake in macdonalds outside the station. first glimpse of europe.
first metro ride to duomo station.
sunday service was in progress. many elderly men and women entered the cathedral, took water from the font and sat down. understood nothing but organ was playing, it was good to experience that.
walked through victor emanuelle gallery and plaza to castle sforza.
castle is covered by ivy and has some sculptures. though the main museum was closed. some girls and boys sunbathing on lawns.
saw la scala from outside. back to square, tram to abbe maria majore. saw the last supper. what an experience. too short a visit.
back to milano centrale by metro.
took a local train to monza.
outside monza station, a long line of buses waiting to take people to the autodrome. bus ride was free.
throughout the day, we had seen groups of boys and girls with ferrari flags in milan station boarding trains to monza, singing songs, shouting slogans.
had to walk about 2 km to the autodrome gates. last few laps were in progress. mr valentine smoothtalked his way into the galleries where we could watch schumacher racing to victory.
as soon the race got over, spectators were allowed on the track and we could actually walk where the cars were racing few minutes ago.
we could see the actual presentation up close. a dream come true.
collected few souvenirs and returned to milano centrale. said goodbye to mr valentine. he was to return to berlin by the evening flight.
got the bag, got in the train and reached genoa at last.
some confusion on the station name. when reached stazione centrale genoa, the conductor did not understand what i was asking him. brignole was next and i just managed to get down by asking some tourists who knew english.
there was a difficulty at genoa.
the instructions said to take a taxi or bus. i did not know which bus to take. genoa is not a tourist spot so no tourist office. information office was closed. it was getting late and dark. did not know what to do.
there was a railway information office. so i barged in. the gentleman politely said this was a railway information office but i explained him my difficulty and he studied a map and told me to take a no 17 bus and get down somewhere.
so i come to the newspaper shop and buy a bus ticket.
wait for the bus for some time. on the wrong bus stop, going in the other direction.
so finally another gentleman helps and directs me to the correct bus stop.
got into the bus. no conductor, had to punch own ticket.
the next trouble is getting down at the correct stop.
no one understands.
showed the written address to a lady who promised to tell me when the stop comes.
and did so. got down herself and showed me where the hostel was and then walked away.
walked across to the hostel and finally found my room.
feet aching. must have walked 10 km from morning, without much food.
the first day's experience was very good. very friendly and helpful people.
i am a stranger, don't speak the language, look like an arab probably but no one shooed me away.
genoa seems a quiet place.
first view of europe and italy is attractive.

italian travels_2

2009-11-07T20:48:00.000-08:00

the visa was finally issued and then started planning the trip. spent some time on the net and decided what to see. as this was a independant trip, without guide and tour operators, all planning had to be done sitting here but it was fun.
read up on italian phrases and printed a set. hardly had to use it though. except bon journo, grazie, per favore, preggo, ciao etc. however, having it increased confidence.
one great thing about inernet; had all addresses of tourist offices, bus routes, train timetables and could plan the trip exactly. how wonderful.
i discovered that the italian f1 race would be in monza on the fourteenth when i was to be in milan and decided to see it if possible.
the tickets are hopelessly expensive to decided to gate crash somehow. the race was to start in afternoon and was to be over by 5 pm. i could be back in milan by 6 and take the 7pm train to genoa which would reach genoa by 8.30 which looked good on paper.
bought a debit card. a new trolleybag and i was ready.
reached mumbai in morning and spent time visiting vasanta paranjape and others. nothing much to do.

italian travels_1

2009-11-07T20:13:00.000-08:00

last week i found notebooks of my trip to italy. this blog did not exist then. probably, blogs didn't exist so after some years, i have decided to post my observations on italy.
my trip happened from a random mail which dr mitra forwarded to me. this was about a two week training program in gaslini hospital in genoa. i sent an application and documents and it was accepted to my surprise. next thing was to get a visa for italy. that necessisated a trip to mumbai as all applicants had to present themselves.
on getting to the italian counsulate in the morning, i was surprised to see a long line of applicants. i had never thought that so many persons wish to visit italy.
there had to be a confirmed airline booking, invitation and proofs of residence, job, profession and so on. which were provided. the airline office was near gateway of india and i visited the office in morning around 10 am. then the consulate asked for it returns which i had not carried. however, i decided to call it a day and went to dadar to take a but to lonavala and then back home.
the taxi ride went off uneventfully and i reached lonavala some time in the evening.
three bombs had exploded in mumbai in the morning killing several people, one near gateway of india.
koustubh was trapped in mumbai as police stopped all traffic. but he was safe and we talked on phone. vidya was comforted.
i spent the night in lonavala. koustubh reached next morning and i left for home.
next week was spent in getting all documents from vivek joshi, professional records from mit, i added few press cuttings also.
second trip was easy. now i knew the routine. met the visa officer and handed all documents and asked her to hand over the passport to my agent as i could not keep coming.
met dr sudhakar jadhav from sangli who was also there in connection with visa.
this time, i was to meet jyotsna who was passing through. we planned to meet at flora fountain but she couldn't make it so i shopped for books, bought churchill's six volume war memoirs and sundry other books on italy, rome etc and returned by train.

naxalism

2009-10-14T06:27:00.000-07:00

roots of naxalism/anarchy are in everyone. even the sanest, rational, educated, professional can turn naxal.
this i realized some time ago.
not being listened to, being ignored, feeling of neglect can make one turn against the society.
once violence is adopted, dialogue is difficult. then the cycle of violence and counterviolence will continue forever.
government meaning ministers and public representatives, government officials which means the lowest constable, talathi, chaparasi and drug dispenser ought to be more responsive; at least to hear the grievance, solve it; if not seen to be taking efforts and even if that does not work, try to escalate the problem to a higher level.
that rarely happens.

when i had an issue to discuss with the management of BXXXX hospital, it took me six days just to be able to speak to the manager. imagine the plight of a patient or worker who might need assistance.
writing to the chairman and patron of the institute, who happens to be a member of parliament did not merit even an acknowledgement; let alone redressal

last week we took our kitten to the vet for intestinal parasites. the vet who knew that i was a qualified surgeon; looked at the cat and prescribed half tablet of ivermetin(10 mg); when the dose is 0.2mg/kg.
the kitten weighed about a kg not more.
we did not know the dose. the drug being new, i had little information.
after the cat consumed the drug, she became unconscious for three days and needed iv fluids, supportive treatment.
when we took her back to the vet to tell him his mistake, he would not look at us in the face and admit the error let alone apologize for it.
we felt like beating him then and there.

dialogue, discussion, responsibility, admitting mistakes can go a long way in restoring normalcy in the society.

2009-10-11T06:11:00.000-07:00

a selection of updated proverbs. Their glass house proverb ("people who live in glass houses should take a bath in the dark") was not so good, but I still quote a few of the others from time to time:

"Rome wasn't built in a day. It just looks that way."

"A fool and his Monet are soon parted."

"A bird in the hand makes it difficult to blow the nose."

And, my favourite:

"Fools rush in and get the best seats.

Ecclesiastes said: "The race is not always to the swift, nor the battle to the strong."

To which Damon Runyon added: "But that's the way to bet."

Brilliant.

Quentin Crisp once said that people who lived in glass houses should learn to urinate with style.

"You don't have to be mad to work here, but it helps" and "Do not ask for credit, as a refusal often offends", which you sometimes see modified as "Do not ask for credit, as a punch in the nose may offend", not unlike the equally cynical "A friend in need is a damned nuisance."

Our proverbs are rather agricultural, and not designed for folk like us, who have never seen a bargepole or taken a horse to water in our lives

All the familiar proverbs were thought up by people for whom it was quite normal to put grist in the mill, lock the stable door and keep dogs out of mangers. We don't do much like that any more.

Technologically, our proverbs are rather agricultural, and not designed to appeal sophisticated folk like us, who have never seen a bargepole in our lives, would not know how to teach anyone to suck eggs (or put them in a basket) and have never seen the need to take a horse to water.

I can't say it worries me particularly. I have never bought or sold a pig, and I have never wittingly handled a poke, but when someone tells me not to buy a pig on a poke, I know what they are on about, and I even find it vaguely comforting to hear the old, homely wisdom.

Not so at Word of Mouth, where they have been encouraging visitors such as Craig Brown to upgrade some old proverbs with the addition of modern baggage such as ATMs and mobiles. "People in glass houses should beware of CCTV cameras," was one suggestion, which shows you at a stroke the folly of trying to invent new proverbs. The day I overhear some stranger in the street saying "Well, if you ask me, people in glass houses should keep a weather-eye open for CCTV cameras" will be the day I eat my hat.

Besides, I really don't think that one person can produce one proverb. I think they arise spontaneously over the years through trial and error. The only person I can think of who has lent his name to ready-made proverbs is King Solomon, who has a whole book of that name in the Bible, and a load of bunkum they are too. "Hope deferred maketh the heart sick, but when the desire cometh, it is a tree of life." That's another one I don't hear in the high street too often.

In any case, it is a fallacy to say that there are no modern proverbs. Here are a few phrases which, I am sure, were not current when I was a child.

"It takes one to know one."

"Chance would be a fine thing."

"Those that can, do, those that can't, teach."

"Garbage in, garbage out."

I have noticed that when people get any kind of illness these days, they go on to the internet to research it, or they go out and buy a book about it, or, judging from my Amazon-fixated friends, they combine the two by going on the internet to buy a book about it. I am much more in favour of them buying a book, as I have no idea how to make money out of the internet, but I can't see me writing an introductory book to the basic facts about cancer. Can you imagine it? The Do's and Don'ts of Cancer, or An Introduction to Cancer, or, as they would say these days, Cancer – the FAQs by Dr Miles Kington. I don't see it. It's not my bag.

Questions like these:

1. Who is the patron saint of cancer?

2. Can the experience of dying of cancer be offered as part of the Duke of Edinburgh's Award scheme?

3. Who was the first person to dare to use the word "cancer" on radio or TV? (Kenneth Tynan? Johnny Rotten? Dr Anthony Clare?)

4. If your spouse dies of cancer, can you offload the penalty points from your driving licence on to his or her unexpired driving licence, and then start again with a clean sheet?

5. It is well known that George VI died of cancer, but was there any link between that and his lifelong hobby of philately?

6. That is, is there any connection between the licking of stamps and stamp hinges, and the contraction of cancer?

7. Has any research been done into this?

8. Why not?

9. Did the king actually lick his own stamp hinges, or was there a Philatelist Royal who did it for him?

10. If so, is there any record of whether the man who licked the stamp hinges for George got cancer or not?

11. Why not?

You see what I am driving at, Gill. The lateral approach to cancer. They may not be questions which everyone with cancer wants to ask, but you cannot deny that you wanted to know the answers, can you? Here are some more questions about cancer:

12. What does it mean to be in denial about cancer?

13. We all think we know what it means to be in denial, that is, to flagrantly ignore the cold facts, but how can you be in denial over cancer?

14. If you're told you've got cancer, how can you deny it, apart from demanding a second opinion?

15. If the second opinion says you've got cancer, how long do you go on disbelieving all the tests and experts?

16. Or does it mean that although deep down you know you've got cancer, you would rather not think about it?

17. Which, actually, is not so much denial, is it, as just cold-shouldering?

18. And there again, if you are one of those cheery customers who have been told you have got cancer but who prefer to carry on regardless, is that denial?

19. Or reckless bravery?

20. And if you are one of those tough cookies who say, "Dammit! I can be cured! I will recover! I am not going to lie down and give in!" What then? Is that denial? Or is it denial of denial?

21. And if you pursue all other kinds of alternative treatment, in search of a cure, are you in denial of the plain statistic that most people will not be cured by alternative treatment?

22. Are optimism and hopefulness only disguised forms of denial?

23. Will I just shut up about denial for a moment?...

Love, Miles

Here's an idea ...

One of the cancer specialists at the hospital told me that statistically my chances of getting through another year were not great.

"But statistics are misleading," he said. "You could be the exception who goes on and on. I have seen it happen. It all depends on your will to live."

"How's my will to live?" I said.

"I've no idea," he said. "That's up to you."

I was amazed. I was so used to having tests done on everything that I assumed there'd be a test for that as well. If they take blood from you, they can test the blood for almost everything – iron level, genes, bilirubin, whatever the man needs to know.

Why not the will to live? So, Gill, Test Your Own Will to Live! Why not?

Love, Miles

Dear Gill,

Famous last words have rather gone out of fashion recently. All the famous famous last words were said by people who died a long time ago. Nobody has recently said anything memorable on their deathbeds, and do you know why? It is because people don't have deathbeds any more.

Oh yes, they die in bed all right, but not in the old-fashioned way, surrounded by grieving or greedy relations, old friends, doctors and priests. The dying man or woman would be propped up on their pillow, and everyone while pretending to weep would be secretly waiting for the dying mouth to open and say something, which I guess is how we know that Goethe said, "More light!" and Pitt said, "I think I could eat one of Bellamy's veal pies", the only example I know of product placement in dying words.

Dying words like those are pretty banal, but of course when they were uttered, the utterer didn't know they were going to be the last words he would ever utter. You can't hang on till you think of something more pithy and then lapse into intentional silence so that that remains your dying statement.

Nevertheless, some quite pithy last words have been recorded... Oscar Wilde, famously, is remembered for two quite different exit lines. One is: "I shall die as I have lived – beyond my means." The other is: "Either that wallpaper goes or I do!"...

My favourite dying words came from the Mexican revolutionary figure Pancho Villa, who lay dying in some flyblown corner of Mexico and found one of his men leaning over him ready to catch his parting words.

"Tell them," said Pancho Villa, "tell them that I said something interesting."

Then he died.

Today, I am afraid, we all pass away cocooned in a final swaddling of drugs and painkillers and would find it impossible to utter any dying words even if we wanted to. As far as I can make out, the only people whose dying words are recorded these days are people who die in accidents or crashes or from sudden untimely death. Lady Diana, for instance, who said something like, "My God ..." which is quite understandable if you've just hit a concrete pillar at over 100mph.

Well, I have a small proposal to put all this right. I propose that we should all be able to register our final words in advance of our death. I propose that, once we have evolved and perfected our final statement, we should get over the difficulties of actually making it the last thing we physically say by setting up a simple, binding legal procedure to safeguard our final words, by ring-fencing them well in advance.

..............................................................................................................................................................

The other day I went into our local health food shop to buy some salt. I don't suppose health food shops really enjoy selling salt, which is now known to be very bad for you as well as being very good for you, but you don't get ordinary salt in a health food shop, anyway.

It was sea salt I was after. Not just ordinary sea salt, either, but fine sea salt. In fact, I could have gone one grade higher and bought fine organic sea salt, but as I can't quite grasp the concept of organic salt, I settled for plain old ordinary fine sea salt.

And as I was queueing to pay for my packet of fine but non-organic sea salt, my eye fell on a small message on the back of the packet. I squinted at it. It said: "Warning: this product may contain traces of nut".

This seemed odd. Why would they want to put bits of nut into salt? Have you ever seen anything like nuts in salt? Then I suddenly remembered that I had. The first time I went to France as a child I remember being very puzzled because all the salt cellars in our hotel contained what looked like little bits of nuts, and I spent our first meal-time digging around in one salt cellar and getting all these bits out, and displaying them on my side plate.

But when my father spotted what I was doing, he told me that they weren't in fact bits of nut, they were bits of rice. The French liked to put bits of rice in their salt, he said, to absorb the dampness from the salt and keep it fluffy and dry. So I spent the rest of the meal painstakingly putting all the bits of rice back into the salt cellar again.

If my packet of fine sea salt had said: "Warning: this product may contain little bits of rice inserted in traditional French style to keep it dry", I would have understood. If it had said, "Warning: this packet of fine sea salt may contain tiny fragments of dried seaweed to make it seem ever so close to nature", I would have nearly understood. But to have bits of nut in my salt ...?

So I queried it with the young man at the till.

"Be honest. How much danger is there of finding nuts in my salt?" I said, showing him the packet.

"Absolutely none at all," he said. "The packet contains 100 per cent salt and nothing else."

"Then why ...?"

"Because the manufacturers have got scared after all the recent deaths from nut allergy," he said. "So they're guarding themselves against every possible complaint. They're scattering these warnings about possible nut content on everything, even things that clearly don't contain nut. It's a panic measure to avoid any sort of compensation claim."

"But if they put warnings about possible nut content on everything," I said, "what about people who really do suffer from nut allergy? What will they be able to eat safely? What will be free from warnings about nuts?"

"Nothing," said the young man. "They will starve to death."

And that may well be the next nut allergy scandal. You'll find some poor sufferer from nut allergy who is unable to buy any food because it all bears warnings about possible nut content, yea, even unto salt and bottled water. And deprived of any safe food he will waste away and starve to death, and his grieving family will sue the manufacturers for putting false warnings about nuts on their products, leading to his death, which will mean that what the big companies thought was a safe, complaint-proof warning about nuts in fact turned out to be a killer. And will we be sorry for the big companies? No, we will not.

Meanwhile, what you all want to know is: did putting rice into salt cellars really keep the salt dry?

Well, sometimes it did and sometimes it didn't. But what the rice infallibly did was get jammed in the holes at the top of the salt cellar, so you couldn't get the salt out anyway.

In those days you were left to puzzle things like that out for yourself. Nowadays, they would have a message on those French salt cellars saying: "Warning: the presence of rice in this product may reduce salt flow, or completely halt it, and thus lead to fatal salt deficiency, and an early grave".

Warning: This article contains material that may be upsetting to those who are genuinely suffering from nut allergies.

....................................................................................................................................................

There is a quite extraordinary trial going on at the moment in the High Court, in which a Mr Jason Cortisone is suing the National Health Service for stealing a hospital trolley from him.

His unlikely story is that... but perhaps an extract from the proceedings will explain it better than I can.

Counsel: Your name is Jason Cortisone?

Witness: It is.

Counsel: That is an unusual name, is it not?

Witness:I don't think so. I have met many people called Jason.

Counsel: It was your surname I was thinking of. Cortisone. I take it that that is your own name?

Witness: I think so. It may be someone else's. I don't know. They've never asked for it back.

Counsel: What I meant was, that is the name you were given at birth?

Witness: No.

Counsel: No?

Witness: No. I got it a few weeks later, when I was registered.

Counsel: Is it not unusual to be named after a drug?

Witness: Most. It never happened to me. My father was of Italian extraction and his forebears came from a small hill town in the Dolomites called Cortisone.

Judge: Excuse me, Mr Forrester, if we are going to spend all this trial discussing surnames, we shall never come to an end. You have done an excellent job of establishing Mr Cortisone's name, but you may proceed now.

Counsel: Thank you, my Lord. Now, Mr Cortisone, I believe you are not a man who likes being in hospital?

Witness: I hate it.

Counsel: You are a hypochondriac?

Witness: This is a condition which has been diagnosed in me. Along with all my other ailments of course.

Counsel: Quite so. Will you tell the court what precautions you took earlier this year to ensure that any enforced visit to hospital might be more comfortable?

Witness: Well, I had heard that you were lucky to get a bed in today's NHS, and that most people were forced to lie on a trolley for days until a bed became available. So I decided to buy a hospital trolley and practise lying on it at home.

Counsel: The idea being to get used to life on a trolley in case you had to go to hospital for one of your many ailments?

Witness: Yes. So I bought a National Health trolley...

Counsel: Excuse me. Where did you get an NHS trolley from?

Witness: You can always get NHS things if you want to. They're so desperate for cash they're always flogging stuff off. That's why they're so short of beds. They keep selling them. I actually got this at a Hospital Boot Sale. I started practising life on it immediately.

Counsel: Did it become more comfortable as you went on?

Witness: Not much. They're very narrow, too, so you're always afraid of falling off in your sleep.

Counsel: I believe this did actually happen to you on 17 July last?

Witness: Yes. I was doing a practice sleep on the trolley when I fell off and became entangled in its lower half. An ambulance was sent for and I was taken to hospital.

Counsel: Still attached to the trolley?

Witness: Yes. I actually heard one of the ambulance men say, "Might as well take the trolley - could come in useful."

Counsel: Were you seen to immediately at the hospital?

Witness: No. I was left for a long time on my trolley. Well, under my trolley, really, as I was still entangled with the lower infrastructure.

Counsel: Did anyone deal with you?

Witness: No. But someone climbed on my trolley.

Counsel: Another patient?

Witness: No, oddly enough. I banged on the upstairs bit from below and said: Hey! You up there! And the bloke on top said, 'Please – I'm trying to get some sleep.' It turned out he was a junior hospital doctor who was knackered due to long hours and decided to have a kip on my trolley. Thing was, he didn't know I had brought my own.

Counsel: Did he stay long?

Witness: He slept until he was awoken by his mobile phone. In his sleepy state, he dropped it over the edge and, trying to grab it, he fell off and had an accident

Counsel: Bad?

Witness: Yes. The phone was completely ruined.

The case continues. More some other time, perhaps.

.......................................................................................................................

Yesterday I began telling you the story of Martin Trapp, an expert in the history of American showbiz, who was kept fully employed writing obituaries of, and tributes to, the aged survivors of the golden age of American showbiz. Indeed, his obituaries were so well thought of that he was induced to publish a book composed entirely of the death notices he had written of other people, which sounds ghoulish but is no more so than any biographical encyclopaedia, which after all is no more than a collection of glorified obituaries...

A reader writes: Just spare us the catchpenny philosophy and get on with the story! Yesterday you said that Martin Trapp was going to die in this episode.

That is not quite what I said. What I said was that Martin Trapp became so obsessed with obituaries that he conceived a desire to know what people would say about him after he died. Now, there was one easy way to find out and that was to sneak a look at his obituary in the newspaper offices where he worked. He was an habitué of several obituary offices, and thought he would be able to get access to forthcoming death notices, and see what had been written about him; in which he was wrong, because security is very tight in these places, on the principle that nobody must ever know what is being written about him before he dies.

A reader writes: Of course, Martin Trapp may have been unable to find his obituary because they hadn't written one about him. Maybe they didn't think he was worth obituarising.

Quite possible, but that wouldn't have occurred to him. Everyone who is in the habit of reading and writing obituaries believes deep down that he too is worth having an obituary written of him.

A reader inquires: So he faked his own death? Well, he thought about it. He toyed with the idea of faking his own disappearance...

A reader asks: Would that have been enough? To disappear? I mean, Lord Lucan disappeared pretty comprehensively, but I have never seen his obituary anywhere.

That was probably because Lord Lucan was a feckless layabout who never did anything interesting or worthwhile. The only thing that Lord Lucan did of note in his life was the very last thing he did which was to disappear before he could be arrested after he had murdered his nanny ... No, Martin Trapp decided to fake his own suicide, but before he could decide on a method which would suggest his death without actually involving a corpse, the matter was taken out of his hands. He was due to fly on a plane to Edinburgh. He missed the flight. The plane crashed. All his friends assumed he had caught the flight, and the airline also assumed that he was on the passenger list. Nobody survived the crash.

Well, Martin Trapp delayed the announcement of his survival long enough to buy the next day's papers, and sure enough there were several long pieces on him. They paid tribute to his encyclopaedic knowledge of showbiz history, which pleased him, but there were other things which pleased him less well. He was accused by several of his rivals of shameless plagiarism and unoriginality. His private life was raked over (Martin had been married, and had then come out as gay and some of the details made racy reading) and the smell that was left by these obituaries was scandalous and sulphurous rather than saintly.

A reader writes: He should have sued them for libel.

And that is exactly what he did! He came back to life and sued the lot of them for libel. He took the view that he was bound to win, and that even if he didn't get substantial damages, he would make history by being the first person to sue an obituary for libel. You cannot libel the dead, you see, but if the dead come back to life, then it's rather different. Now, normally the defence in a libel case is either that the libel is true or fair comment, but in this case all the obituarists pleaded that Martin Trapp was deemed dead at the time and therefore was de jure if not de facto dead, and therefore they were justified in being as frank as an obituary would allow.

A reader writes: And what was the outcome?

Lord Lucan writes: I must warn you, Mr Kington, that I fully intend to sue you for libel for saying earlier on that I was a layabout and murderer and that I never did anything worthwhile in my life.

A solicitor writes: I would advise you, Mr Kington, to say no more on this matter and end the article right here.

Miles Kington writes: Righty ho.

......................................................................................................................................................................

Today: three little moral tales for our times.

1. Once upon a time there was an only child called Robert. If Robert had one fault, it was being too clever by half. When, for instance, his mother said, "Good night, sleep tight, don't let the bugs bite," Robert said: "I am not sure that bugs actually do bite, mother. Some of them have pincers, some of them have stinging equipment, but teeth? What bugs have teeth, mother?", and his mother smiled, but inside she felt like strangling him.

One day in his teens Robert told his mother that he had decided to go in search of his adoptive parents. He explained that as all adopted children had a natural set of parents elsewhere and often felt an urge to track them down, it seemed a logical pattern that children like him might also have a set of parents elsewhere who would have adopted him if things had been different. He now felt an urge to search them out.

"Go ahead," said his mother. "Make my day."

And so, when he was 18, Robert set out into the big wide world, and he did after some time find a married couple who had always wanted to adopt a boy but had never managed it.

"You were exactly what we wanted," said Mr and Mrs Touchstone, which was their name.

"You mean, you wanted a little curly-haired boy called Robert whom you could bring up in your own image and teach to play football and cricket?" said Robert.

"No," said Mr Touchstone. "What we wanted to adopt was an 18-year-old prig like you, who would leave home almost as soon as we had adopted him, having been trained and brought up by someone else. Now get out."

And Robert did get out, and he went back home to his real parents, but they had taken the opportunity to move house in his absence without leaving a forwarding address.

Moral: Omniscience is all very well, but being a know-all is unbearable.

2. Once upon a time a householder called Mr Carruthers decided to take everything out of his shed and sort it out, before putting it all back in again, which is what men do when they say they are "tidying up". As he surveyed the junk in his yard, he heard a voice behind him say: "How much are you asking for this?"

It belonged to a complete stranger who had wandered down into the yard and was pointing at an old lawn mower. Mr Carruthers quickly realised that the chap had mistaken his pile of stuff for a garage sale, and had the sense to ask eight quid for the mower. Then someone else bought two lamps, and a woman bought an old basket, and by the time his wife called him in for lunch he had made £130.

He was about to tell her all about his profitable morning when she said, "Oh, by the way, have you come across my mother's antique Japanese umbrella, the one made of lacquered paper? I've been looking for it everywhere, and I have no idea where it is, and she told me to look after it as it's priceless and must be worth £5,000 by now."

Mr Carruthers said he hadn't. Which was not entirely true, as he distinctly remembered selling it to a stout lady 20 minutes previously, for a fiver.

Moral: Oops.

3. Whenever Mr Finch drove badly, Mrs Finch reminded him that statistically speaking women were far the better drivers. In return, whenever Mrs Finch made a hash of parking the car, Mr Finch reminded her that women had far worse spatial awareness than men. And eventually, when they were driving 200 miles home from London one day, Mr Finch had a brilliant idea.

"You are a far better driver than me, my dear" he said, "so you drive all the way home. And then we will swap over and I will park the car when we get there."

So Mrs Finch drove all the way, and when they were 10 yards from home, she stopped, and got out, and Mr Finch also got out, and because he was not looking he was struck by a passing bicycle.

Moral: It could have been a lorry, but I didn't want a really unhappy ending

.........................................................................................................................................................................

miles kington, writes so well. no more. may rest in peace!

vivek

teacher quotes

2009-09-15T21:47:00.000-07:00

a teacher affects eternity. he can never tell where influence stops.

in teaching, you can not see the fruit of a day's work. it becomes apparent after 20 years.

a teacher makes himself progressively unnecessary

a good teacher is as rare as a good doctor but of course makes less money

qualities of a good medical teacher: sympathy, moral and intellectual integrity, enthusiasm, ability to talk, knowledge of subject

purpose of a teaching hospital is to advance knowledge, train doctors, set an example of practice

those who can do, those who cannot, teach.

safest thing for a patient is to be in hands of a man engaged in teaching medicine. in order to be a teacher of medicine, the doctor must always be a student.

experience is the great teacher. unfortunately experience leaves mental scars and we as surgeons know that scars contract.

errors of judgment must occur in practice of an art which consists largely of balancing probabilities.

good teachers are costly but bad teachers cost more.

poor governance in hospital

2009-09-15T20:56:00.000-07:00

two months ago, a sick newborn in a large local hospital needed surgical intervention. that hospital does not have a pediatric surgeon on rolls. therefore the pediatrician called me in consultation and then the fun began.
i advised surgery.
patient agreed.
question: where should surgery be done?
answer: same hospital as baby is too sick to be shifted here and back; he will still require neonatal care even after surgery
question: permission is required from hospital administration. hospital charges an exorbitant amount towards ot charges.
answer: fine, obtain confirmation from admin and patient
question: hospital admin agrees to allow you to operate; patient willing to pay charges. how early can surgery be done?
answer: asap whenever ot is ready.
question: we don't have neonatal instruments in hospital. can you bring your own?
answer: will bring neonatal instruments, hospital will have to provide linen and routine instruments. will bring some suture material also.
question: come asap

i prepared instruments and went to the hospital. went to the ot, spoke to anesthetist about procedure being done under local. he agreed.

shifted baby to ot, tied him up, administered local and procedure completed.
visited patient two or three times for observation and further care.
patient discharged at the end of one week.

two months passed and hospital never bothered to pay surgical charges.
i had to call the referring doctor to enquire.
then two days later, a cheque is delivered, three weeks after it has been dated and signed.
hospital deducts 15% money as 'service charges'.
i speak to the accountant who says, ' deduction of 15% amount towards service charges is the rule'
i tell him, when did you tell me about this rule?
he says, we do it for everyone, all doctors in the hospital.
i tell him, i am not part of your hospital. where is our agreement? did you tell me you will deduct this amount?
he says no.
i tell him, in that case, you must pay in full.
he says, i can't do that; this will have to be done by the administrator.
i tell him, fine do that and let me know.
i receive a call from the doctor who vaguely says, the accountant told him (the doctor) that he ought to have told me about the deduction.
i ask him not to trouble himself and refuse to discuss the matter further.
accountant does not bother to refund the money or even call back.
i have to call him again to enquire.
he dodges the issue and states that the administrator will do the needful.
i call the adminstrator who puts me back to accountant who repeats himself; this is the rule and we do it for all doctors etc etc.
i ask to speak to administrator who refuses to take calls.
i call his personal assistant and he too can not make the administrator take calls.
call a senior doctor who happens to be a trustee of hospital; and a industrialist whom i know (or thought i knew) and tell them of this matter.
they promise to look and call.
they never do.
this despite both of them being family friends for more than 30 years.
not even call back!
what a shame.
i have to call the doctor again, when he repeats the statement about 'the rule'.
what kind of 'rule' is this? i fail to understand.
this is a matter between two individuals, hospital and another doctor. whatever rules are in place should be made aware before the act and not afterwards. this is common business practice.
eventually i get the administrator's personal phone number and button him.
when i go to meet him, he repeats the same thing about 'rule'
when i ask him about a written agreement, he feigns surprise and calls the accountant.
accountant repeats himself and then finally says that he will 'recover the amount from patient or the doctor and then make restitution.'
i ridicule him and ask him to do whatever is necessary but refund my money.
then the administrator asks for three days and says, he will call.
i finish a long procedure, lienorenal shunt, lasted for nearly six hours and come back.
when called, he says, he just signed the cheque.
but never bothered to call, as promised.

these hospitals think that doctors are like hamals or handcart pullers on mondha. waiting to be called for work and then being paid a pittance.

when will they learn to be professional?

teacher's day

2009-09-15T20:39:00.000-07:00

i am surprised to see so many of you as my students. frankly, i had clean forgotten that i ever taught you surgery. i had also forgotten what actually i taught you in classes. i am sure most of you will have the same thoughts.
please don't be scared. though i am a teacher, i am not going to speak for one hour.
it has been said that there are four types of teachers. first type has bright ideas, imagination but is not very good at actual work or at teaching. he can be a great inspirer. the second type of teacher is an audio compact disc. he repeats the same lecture every year, year after year. third type is a good worker but can not teach very well. a rare good teacher combines all these qualities. however, these days, most medical teachers i come across have neither imagination, skill or teaching ability. poor students!
a famous quote is ' those who can, do; those who can not teach!'. this so untrue, especially in medicine where most, if not all teahcers have to work as well as teach.
what we ought to remember in medical teaching is that the purpose of a teaching hospital is to advance medical knowledge; train doctors; set an example of practice. if we don't do any of these, we are failing our job as medical teachers. these days, the emphasis seems to be on constructing new buildings worth few crore rupees, purchase of new equipment worth many crore rupees. but the main purpose of a teaching hospital seems to be lost.

in teaching, the fruits of your effort are not visible the next hour or the next day. it takes 20 years or so; as i have realized today. i see so many respectable members of the medical profession sitting here, i have to pinch myself to make sure i am their teacher.
a good teacher is said to be as rare as a good doctor, but he makes less money. the government of maharashtra has done much to remove this anomaly. not it behoves the teachers to become good teachers.
i will conclude by saying how pleased i am to be here in this classroom, addressing students. these days, i continue to be a teacher but such occasions, ie being in classrooms, speaking to students have become rare.
thank you.

2009-09-14T16:58:00.000-07:00

despite dr tatyarao lahane being awarded padamashree, the only person who graduated from this medical college, the college/student's body/teachers no one has thought it fit to formally felicitate him. what a shame!

2009-09-14T16:52:00.000-07:00

dr vare died recently and i could not attend his funeral as i had repaired om kasliwal that morning.
dr vare was a good teacher, i distinctly remember his classes on embryology, histology. he may not have been a showman like dr bansal but was consistent.
laid down the law in dissection room too.
me, sanjeev deshpande, baukhandi and shrirang were in the habit of sneaking down to the canteen for a cup of tea between the demonstration and dissection. we used to return by the back door when almost all had returned to the dissection room already. this went on for some time but we were caught finally.
let off lightly of course.
when he became dean, he happily allowed us to stay absent from internship and attend the basic mountaineering course in manali which lasted for a month; and allowed us to take train travel concession too.
then when we went to take aiims entrance examination, that time too he let us travel half fare and encouraged us to appear.
even afterwards, he ever used to behave well. i remember him standing in front of MGM opd in the morning. his example was enough to make everyone work better.
he inaugurated dr rajurkar's dental clinic and remembered his principal late g.n.thatte fondly.
dr vare was a good teacher, a man of simple habits, a thorough gentleman. such persons are rare.
i salute him

teacher day festivities

2009-09-14T05:19:00.000-07:00

students of 1985 batch invited me to attend the teacher's day bash. it was to be in one of the lecture halls but when i got there, the room was locked. then someone said the function is in the auditorium. when we got there, the auditorium was quarter full. more teachers than students. i saw many local doctors; i had never known that i had ever taught them. and they too previously had not let this fact be known to me whenever we had met earlier. this surprised me.
i found my own teachers sitting in the hall waiting for the ceremony to begin.
there were only two teachers who were younger than me. small consolation.
function began late as usual and went on for quite some time. dr dande conducted the ceremony, he had a good word for every invitee and many teachers spoke a line or two. it was two p.m. before it was finally over.
we all received a rose and a flat box. i thought it was a clock or something. when i got home i found, it was a nirlep frypan.
funny!
lunch followed.
then shradha called me to attend the function in surgery department. went there but the room was occupied by another group.
seminar hall in pediatrics/obs all were full of people eating stuff when every hall was marked 'foodstuffs not allowed inside the hall'.
as expected, function was to begin at 3 p.m. and no one was present at 3.15 p.m. so went home.

music on net

2009-08-03T23:13:00.000-07:00

so much music is on the net; classical hindusthani vocal, instrumental, films. classical western, operas, pop.
i got the song boycrazy that's what love can do after a long search. it wasn't available for many years but it is now.
it is a very haunting tune, nice words, good choreography. i wonder why the group did not do well.

jogging, fitness

2009-07-22T21:21:00.000-07:00

did 8 km this morning. speed isn't much but stamina is allright. should be able to do the half marathon sometime next year. marathon is not possible.
but it might be because, did 10 km on 2nd august. now i can do 8 every day without much tiredness. and then do some weights, and then operate too.
will do the 5 km run this year, and half marathon next year.

solar eclipse flop

2009-07-22T21:18:00.000-07:00

yesterday's solar eclipse was a flop as expected. no one, almost no one in the country could see the corona. what a shame.
our own plans of going to arunachal fizzled out. then we thought of going to nandurbar but that too had to be cancelled as mamashri and vikram cancelled and then there was no good company.
we missed it but so did so many others. our disappointment was shared by millions.
ought to consider going abroad for another eclipse

bombay traffic

2009-07-22T21:09:00.000-07:00

i was in mumbai last week for admission and it was raining heavily when we got down at dadar. it was difficult to get a taxi to andheri and most were demanding rs.500 to 600. i got one old man who agreed to take us for rs.300. we got in somehow in the pelting rain. the taxi was smelling something odd. which was expected considering that it had been raining for three days. the driver took off along hindu colony, matunga towards dharavi(probably). heavy rains made identifying landmarks difficult. little could be seen from windows.
then i realized that the windshield wipers were not working and the gentleman was driving merrily at 70kmph. what nerve.
at the same time, the traffic was so orderly even in heavy rain, it was not too difficult to drive. nobody was jumping lanes. there was no oncoming traffic. no one driving on the wrong side. almost all drivers had switched on the headlights and both side blinkers which served as good guides.
we went all the way along the highway, airport in heavy rain. even two wheeler drivers were driving quite well dressed in full rainsuit, helmet.
mumbai discipline has to be admired.
out here, slightest rain and everyone starts driving like mad.
traffic mostly stops, at least twowheelers. cars too slow down. buses and trucks won't stop.
what contrast.
something to be learnt from drivers in mumbai.

residents on strike

2009-07-09T21:03:00.000-07:00

residents in all government hospitals are on strike for increased stipend. this is a wrong time for a strike. monsoons are failing, prices are high, petrol prices have been hiked, industrial slump is going on. people will not be supportive. without people's support, the government will not bend.
they ought to have shown that they (residents) are working to save the exchequer so much money which otherwise would be paid to full time doctors.
a resident who works properly does the work of three full time doctors who would be paid at least double the salary of a resident.
the full time medical officer would be entitled to 12 days casual leave, 30 days paid leave, medical leave, pension, provident fund, gratuity, leave travel allowance, medical reimbursement for family and self, overtime, day off for extra work and what not.
residents are not entitled to any of these perks, still most of them work hard, if not for work, but for their degree. so what, work is work.
they have no working hours, no holidays, no offs. no opportunities for extra income as are available in some other departments where people work long hours.
a public education campaign should have begun some time ago to highlight their inputs; a one month 'soujanya ' campaign where all residents behaved extremely politely with patients would have helped the image.
as of now, a resident is perceived as a person who works but is rude and short tempered. despite their efforts, they manage to antagonize lot of people.
this strike will only end in an impasse.
alas!

academic pentathlon

2009-06-15T23:33:00.001-07:00

i wrote about the academic pentathlon class xii students have to take. it make me very happy to state that s......a did well in all the five examinations he took.
iit-jee
bitsat
xii board
mht cet
aieee

if one knows the subject, the pattern does not matter.

one should be able to play on all surfaces, lawn, clay, hardcourt

academic pentathlon

2009-06-15T23:33:00.000-07:00

masochism

2009-05-27T08:26:00.000-07:00

while working in the g...i hospital the other day, i thought that most surgeons are masochists. who would want to work standing up, wearing hot and humid clothing, under a hot light, for several hours every day, dirtying one's clothes, hands (sometimes underwear); doing jobs which not many sane individuals would do, and for not much money.
then working in g...i hospital is so much more fun.
the table is too broad, one works at arm's length.
the height can not be adjusted
light does not focus.
servants disappear.
s.....s have poor training, good motivation though; leading to constant commands and general mother-in-lawing.
a.......ts are poorly trained in basic skills, come to ot without reading about the procedure steps and then ask silly questions and are mostly a hindrance than help.
often i feel like the marcher in moharram or 'bhopia' who flagellate themselves in public.
there must be a masochistic streak somewhere.

suparna's result

2009-05-26T00:44:00.000-07:00

suparna stands 1125 in iitjee. which is considered very good by everyone. i can't make out anything with these numbers but it probably means he will get admission to one of the good iits in a regular course so it must be good!
so many are calling on telephone, messaging, mails. it is a wonderful feeling.
enjoy it till it lasts.

he stood 300th in aieee, state rank 32

bits pilani score 395

board examination 95% pcm
92.3 overall

wedding receptions

2009-05-06T21:20:00.000-07:00

wedding receptions have become a pain. most don't start on time. in summer, hanging around in a crowded hall, without ac or fans is a torture.
then there are a hundred guests waiting to wish the couple, standing in line and the pandit is doing some silly ritual. and the photographer starts to shoot pictures as if the relatives are going to run away very soon.
one must remember that the hundred guests have come a distance to wish the couple well, most are not intersted in the food. they just quickly wish to meet the bride and groom, their parents and make a exist. this ought to be organized better. and often the bride and groom start chatting up people and cracking jokes while another fifty people are standing with gifts, bouquets. and then someone wants to take a picture of the guest with the couple. another few minutes wasted. bajaj auto should initiate some advisory exercise to move things along.

pleasure of medicine

2009-05-06T21:08:00.000-07:00

vithal jadhav came the other day. of course i did not recognize him after nearly 12 years. i had removed his right lung when he was 11 years old and had been suffering from fever, cough and sputum for months with a bronchiectatic lung.
this was the first time i was doing a pneumonectomy and now i can admit that this was a most difficult undertaking. dissecting at the hilum of lung, separating pulmonary vessels; your heart is in the mouth. gives one apnea. but somehow we pulled it off and patient made it home. we met him some years ago while going to sultanpur to a hurda party.
now he is employed in mumbai in a office as computer operator.

met tinku g's mother at the iitjee examination. tinku had posterior urethral valves and underwent fulguration, ureter reimplant, excision of diverticulum, herniotomy over 8 years. parents were anxious, as expected, father being a engineer, mother college professor. when the last dtpa scan showed good drainage in the bladder, they were satisfied. now he is a strapping young man, trying to get in the iit.

and aneesh d in naivedyam hotel this sunday. could not recognize him as again. but mothers don't change as much as children do so. he had undescended testis and underwent orchiopexy. then had appendicitis and underwent appendicectomy. old family, educated, rich, well-to-do. one rarely gets such patients. but very well behaved, polite and not nosey. aneesh is tall, well built and very handsome.

v.b. had undergone bilateral herniotomies in 90 or 92 and is now in purdue university, indianapolis doing engineering.
his brother had ileal atresia, then left hernia, then right hernia, and finally torsion testis. he is in class 9, almost 5'9" and very intelligent.

rohit r is not doing well. he had pouch colon, my first cpc. had ileostomy, a difficult pullthrough, colostomy closure, reexploration for adhesive obstruction, then bladder stones twice. he is one sick puppy.

m.d. is another sick young lady with cpc. she too had ileostomy, pullthrough, closure. then came malone procedure using ileal tube which necessisated another laparotomy for adhesions.
now the malone has sealed off.

pleasure and pain, as long as pleasure is more than pain, it is worth the trouble.

preaching

2009-05-05T06:10:00.000-07:00

a senior professor is quite fond of preaching. and i have to take issue with him quite often. some months ago, this issue of usig came up and the gentleman was very emotional when i declared my intention to perform one. he almost called the fire brigade to stop me from doing it.
now few months later, he quietly admits that he too has done usigs in some patients for same indications.
this time the issue was chemo for wilms'. he believes that a clinician ought not to take responsibility for chemotherapy. but prefers to be silent on the alternatives.

but i have found support in certain quarters and am going ahead with my original plan regardless of dr preacher

sentimental nature lovers

2009-05-05T05:59:00.000-07:00

what i find difficult to tolerate is a sentimental nature lover. nature is fine but nature is cruel, nature does not forgive, nature does not give you a second chance. nature does not care for personalities, status, reputation. city bred bird lovers and tree huggers find it difficult to digest but they ought to understand that for a single surviving tree, thousands have died in infancy, eaten by bugs, cows, trampled by people and animals and what not. every little bird kills hundreds of insects and worms every day. now all those insects and worms too have a life and so on but a bird is considered beautiful and a worm is a lowly creature made just to satisfy the bird's appetite!

i found this essay quite readable and will quote it here.

http://www.m4040.com/Survival/Mother%20Nature.htm

"Mother Nature Is a Cruel Bitch

I write this addendum to the site because many folks have forgotten what nature and wilderness are all about. When I surf around the net, I discover abundant quantities of Birkenstock brain-mulch on the subject of nature, most of it being pure crap. When I watch the news, I hear about hikers dying. This is because many shrub-cuddling types out there have forgotten the truth about nature, and are now yammering on about how warm and fuzzy it all is. The truth is that nature can be a cruel bitch."

it is worth reading in full.

kasab security

2009-04-29T20:08:00.000-07:00

a recent report states that the government is spending few crores on keeping secure and safe in the prison till he is tried, pronounced guilty and then hanged.
spending so much on a person is riduculous.
it might be more practical to house him inside 1 racecourse road or rashtrapati bhavan which already have plenty of security in place.

the update at mamc went well, though attendance was somewhat thin. presentations went well, though in such meetings it is difficult to define audience expectations. time is rather short to discuss the technical points in detail and as it is, talk does not help in technique. however! i hope the audience liked it. so many complimented on quotes, i thought it was a shame, being complimented for the wrong reasons.
of course, all being qualified surgeons with more than 15 years under the belt, there is little by way of scientific information that is going to be new to them.

meeting v.k. after nearly 30 years was a experience by itself. it must have been october or september 1982 when i last saw her in delhi. soon after i had to rush to mumbai to attend dada's first surgery and then life changed.
being a very senior officer in delhi has its own charm.

air travel

2009-04-26T05:54:00.000-07:00

air travel is a pain contrary to what most would believe. even short trips. i used to feel envious when two of my traveller friends would remark that they just returned form frankfurt and will be going to malaysia. what a headache. sitting in the car to airport, sitting in the lounge, sitting in the plane, sitting in the car to the office, sitting in the office, sitting for lunch, sitting in the car back to airport, sitting in the lounge, sitting in the plane, sitting in car back home and at last eat a good hot meal and sleep! no wonder, first class tickets cost so much.

anita is my stewardess and i shall not want
she leadeth me to my allotted seat, she fasteneth my seat belt
she restoreth my soul, she makes me walk in the aisle towards the appropriate row for the airlines sake
though i walk in the valley of shadow of death, i fear no evil for the oxygen mask is with me, the life jacket is under my seat
thou preparest a table for me in the midst of other passengers, thou serveth me with insipid, artificially heated food, my cup spilleth over
surely tail winds will follow me all the way in the flight; i will reach the terminal at last; sleep securely in my house at last (hopefully not forever)
amen!

back to basics

2009-04-20T07:46:00.000-07:00

xxx is back after ten years, having worked in other hospitals. not much change in work, has learned some new skills. let us see how things work this time. things work well for few months and suddenly, chaos erupts. people should take a break from time to time. this they don't and then disrupt routine.
elections are not noticeable, there is hardly any noise, no banners, no posters, nothing. this afternoon, in the market, there was some noise. otherwise, this must be the silentest election so far. good for a change.
weather is very hot and makes training very difficult. my times are going down to 33 minutes now. it was 29.25 two weeks ago. but i could do 7.5 km non stop yesterday. for someone my age, this is all right i suppose.
have lost at least 10 kg, am feeling fit and fine, strangers are remarking that i am looking thin!
if i lose another 5 kg, then bmi would be ideal and then i won't have to work so hard to lose weight. this diet is a strain.

presentations

2009-04-19T05:16:00.000-07:00

i ought to upload my presentations somewhere. getting it from the disk is becoming more and more difficult. can one upload files in the blog or will need an esnip account probably.

staff shortages

2009-04-19T05:13:00.000-07:00

getting skilled people who are dedicated to work, who do not steal, who behave well with customers is becoming impossible. i think expecting a single person to have all these qualities is asking for the moon. but for small businesses, staff has to have these qualities. one can not have specialized staff for different functions. that is the trouble with office practice, that can be an advantage too. there is more variety in work, one can multitask, learn new skills, generally become a better worker. why don't people learn!

academic pentathlon

2009-04-19T05:07:00.000-07:00

ancient olympic games had a pentathlon event, which included running, wrestling, discus throw, javelin throw and long jump.
modern pentathlon includes hurdles, running, shot put, high jump and long jump.
the way class 12 students appear for a variety of examinations, the board, iitjee, aieee, mht-cet, other state's cet, vit, bits and what not; they are going through an academic pentathlon.
there ought to be a overall champion in these examinations. each has a slightly different syllabus, a different examination pattern, a different method of grading and the event lasts two months! what a test of stamina!

iapscon08

2009-02-12T02:36:00.000-08:00

the conference in guwahati passed off nicely, except for the expulsion of dr sarin for five years. that was unfortunate, more so because i was absent from the gbm and could not raise a voice of protest.
of all the foreign delegates, only dr ralf bodo trops stayed. was it because of his name?
guwahati is a large city, spread wide along the river brahmputra. mostly on the south bank. airport is 40 km from the city. strange.
no high rises. visible security.
cool mornings, afernoons hot. staying alone, not much to do in the morning. watch tv. news is depressing as usual. tea is very good, naturally. hope the same is true with petrol.
day breaks at 5 am and sunset at 4.30 p.m. by 5 pm it is very dark. faces softer. not exactly eastern, but midway.
labourers carrying a long 'phawda' and bamboo basket.
NO traffic lights. roads mostly bad except for the bypass. drivers very fast. transport expensive. rikshaws/taxis; no meters. bargain and pay through the nose.
kamakhya temple very small. unlike other temples. access limited. many pigeons all over the place. killed by cats and eaten. pujaris don't bother. feathers, blood lying around. pandas wear red dhoti and red shirt. knew very little puran. many shops selling prasad, bangles on the way.
brahmaputra river crossing costs six rupees to and fro. ferries run opposite the wharf at paltan bazar. crossing lasts 15 minutes one way. lot of two wheelers use the ferry. people businesslike. naturally, they are doing it every day. must be difficult when the river is in flood.
time not very important. the taxi to shillong turned up only one hour late. airport drop car came only 30 minutes late. drivers very young and drive very fast.
shillong, all women wear a long skirt, top or a maxi and wear a chador pinned to one shoulder. everyone carries a purse across the shoulder. matriarchal system of property.
every child of walking age wears trousers, shirt, shoes and a jacket. everyone looks so well dressed. compared to that, people home look like beggars.
all wome wear lipstick, chew supari all the time and spit vigorously.
shillong market, full like chandani chowk. bargains for windcheaters and cheap clothing.
lots of chinese food being served.
shillong is a beautiful city. clean, good roads. nice houses.
the best food ever. in a bengali restaurant in shillong. five of us ate lunch, bill rs 155. plain rice, dal, fish, egg curry. hot spicy, clean. excellent.

interesting facts

2008-11-07T02:01:00.000-08:00

the first documented anesthesia death occured on 11 february 1873

there is a statue in boston, dedicated to the father of anesthesia, however, there is no name under the statue.

fewer people are killed using illegal drugs, than legal drugs

morton was late in arriving to administer the first ever anesthesia, the tradition continues.

morton was born on 9th august 1819, and died on 15th july 1868, a broken man.

morton, lang, jackon, wells all fought for credit for the discovery of anesthesia.

re:learning from long term followup

2008-08-16T17:21:00.000-07:00

we have to let the patient go at some time in treatment. patient needed our
services, we were able to provided the service; and he even recovered from
illness despite our efforts. now is the time to cut the umbilical cord and
release him.
the desire to have patients depend upon us for their health issues is
normal, we are human after all. this often escalates into patient coming for
trivial medical illnesses, then for family counselling and what not.
just because a surgeon operated on a patient at some point, does not mean
that the surgeon is responsible for all the health issues for the rest of
patient's life.

while helping patients as much as possible, we ought to develop a
detachment. it is necessary for his and your own peace of mind.

a senior surgeon has compared a surgical patient with a daughter getting
married. the surgeon wants the patient to go home and not return too often.

after practicing pediatric surgery for nearly 20 years, it often is
difficult to think clinically about adult problems, and the logistic
problems are difficult too.
one does not mind giving enema to a child or if a neonate micturates on your
hands. how would one feel if the same act was repeated by a 30 year old
patient?

2008-05-05T07:13:00.000-07:00

महाराष्ट्रात वारंवार होणारे नीवासी दोक्टारान्चे संपा हा शासनाच्या अनास्ठेचा परीणाम आहे। जनतेला उच्च दर्जची वैद्यकीय सेवा अल्प खरचत पुरावीने ही शासनाची वैधानीक जबाबदारी आहे। वैद्यकीय सेवा ही दोक्टार नर्स तन्त्रद्न्य यांच्याशिवय पुरावीने अशक्य आहे। अजाही बहुतेक वैद्यकीय महाविद्यालयाच्या रुग्नलायत हलक्या दर्जच्या उपकरानान्नी, औशाध्याच्या अभवत, रुग्नन्ना वैद्यकीय सेवा उपलब्ध होत असल तर टी मोजक्या सेवाव्रती दोक्टारांमुले।

information and consent in medicine

2008-05-05T06:36:00.000-07:00

patients and parents expectations of being informed are likely to be overly expectant because even among the practitioners of the art, there can not be a consensus on what is the "best option" especially in a complex condition like posterior urethral valves, which dr joseph has discussed in iaps forum.
what parents and patients ought to realize that despite the jargon, most of us will write the anatomical and pathological diagnosis; will write a plan; prescribe medicines openly; which are available in the nearby shop; and also write the operation note; anesthesia notes; progress notes; prepare a record which is mostly objective and can be understood and evaluated by any other practitioner.
for the one thousand pediatric surgeons in the country who can rightfully claim to be able to understand the complexities of posterior urethral valves; there are a million homeopaths, ayurvedic doctors, unani hakims, naturopaths, electropaths, bach color remedy specialists, reiki masters and what not; who would consider it in their purview to treat a child with "disorders of urine".
as this without any specific diagnosis; plan; evaluation; and medication which is often secret!
patients want their doctors to be well informed but are patients competent to receive all information?
does our job as practitioner of the art and science of surgery, also include teaching this to laymen?
there are less than 20 centres of post-graduate education in pediatric surgery in the whole country. MCI takes it that there are only about 40 to 100 persons in the country who can teach pediatric surgery to persons who have a sufficient background to understand it. and this understanding takes almost three years! so how do the remaining 900 pediatric surgeons should explain the intricacies of illnesses to uninformed parents in 10 minutes or less?
a general practitioner's daughter had appendicular pain and he consulted two surgeons who did not take out the appendix; because the sonography was "normal". the g.p. commented that most surgeons seem to have lost their confidence. they need the crutches of radiologists and others to do their diagnosis.
the line between too little and too much information is thin.
we are supposed to be able to perform surgery on patients, not talk about it.
if a patient starts selecting surgeons on the basis of "talk", this can only lead to further specialization like "surgical marketing", "surgical operations", "surgical after sales service" and so on.
the great osler once remarked that "there are doctors who work with their brains and those who work with their tongues!"

we ought to tell the patient what we feel is the diagnosis;
what we intend to do;
what is the likely progress and outcome.
explaining the reasons for everything is overdoing it. the patient does not understand it; can not take a judgment call.
patients want their doctors to be rich but not at their expense
patients want their doctors to be well trained but the training should be obtained on someone else; not on themselves.
patients want their doctors to perform the latest operation, prescribe the latest medicine but want that this has been tried on someone else earlier.

more often than not the doctor patient dialogue turns into a full scale interrogation! let us hope parents don't demand that their surgeon undergo a narco-analysis or brain mapping.

parents should be informed (this is a job for the associations) that as a group, the pediatric surgeons are best qualified (in all respects) to take care of the surgical conditions affecting children. society also must know that there is no consensus among the group on the "best" treatment of certain conditions because the matter is still evolving; enough information is not available. therefore, some differences are possible if two different surgeons are consulted or the same surgeon may give different opinions at different times.
we read advertisements about ipos, new shares, mutual funds and finance schemes. often the prospectus which is supposed to give full information is several pages thick and full of text, pie charts, trend curves, tables; that a layman finds it difficult to undestand. we know that many companies are expert in financial window dressing.
every mutual fund states that;
1. the end result is subject to market risk, government policy and expected returns may not materialize.
2. maha suraksha, maha gain, maha profit, gold growth etc are only names of the scheme and do not reflect the innate quality of the scheme.
3. for a mutual fund worth 20 crores the parent company/bank invests a princely sum of rs 10000 or thereabouts.

mandatory disclosures have not helped investors.

mandatory disclosures, explanations, dialogues, counselling is not likely to be as productive as it is made out to be; especially in a emergency clinical situation.

in the agricultural sector, there are researchers who develop new seeds, plant varieties, fertilizers etc. and extension workers who go out and explain to the public the benefits of these innovations.
it is not proper to expect the person who does the job to also explain everything to the layperson.
when we ask a tv repairman, mechanic or plumber to look at faulty equipment; he spends some time and states that "such and such is wrong and needs to be replaced; it will cost so much". and we pay him the money and ask him to to the job. certainly these gentlemen haven't spent 12 years of their lives learning to do this job? they haven't been the top 500 students in the state have they?
so how is it that in a simple situation, no explanations are demanded and given, while in another situation, full explanations are demanded and seem to be the norm.
vivek gharpure
aurangabad

2008-04-28T21:30:00.000-07:00

2008-04-28T21:28:00.000-07:00

2008-04-28T21:22:00.000-07:00

2008-04-28T21:21:00.001-07:00

Dr Vivek Gharpure

Hon Asst Professor

Department Of Surgery

Government Medical College And Hospital

Aurangabad

29^th April 2008

The Dean

Government Medical College And Hospital

Aurangabad

Subject:- Difficulties in providing optimum service to poor patients coming to the hospital

Sir,

This is to bring to your notice the following facts. It is hoped that suitable action to redress the difficulties, which will help, provide optimum service to poor patients coming to this hospital.

Surgical diathermy machines in operation theatre no 3 have been malfunctioning since a long time. This Saturday, the diathermy machine stopped functioning when a patient posted for decortication for chronic empyema was intubated and positioned for surgery. The surgery had to be carried out with the cautery working all the time; which exposed the patient to risk of cautery burns.

2. I had written to dean’s office on

4^th October 2000

4^th January 2004

16^th January 2004

4^th may 2005

29^th December 2005

15^th June 2006

3^rd august 2006

regarding the non-availability of appropriate equipment, instruments, consumable materials in the operation theatre. However, no action has happened. The situation is just as before.

Even today, many operations are performed using my own personal instruments. Patients still have to purchase costly suture materials.

Patients with imperforate anus have to be referred to mumbai for treatment, as the hospital does not have a surgical muscle stimulator. (A demand for the equipment was submitted on 8^th February 2008)
Newborn babies born in the hospital or admitted to pediatric wards and suffering from major congenital malformations require immediate evaluation, treatment planning and surgical intervention. They are first referred to surgical unit on call. The surgical unit in turn advises the admitting unit to refer the patient to pediatric surgeon. This results in delay (up to 24 hours) in treatment.
Despite these difficulties I have been able to perform more than 900 surgical procedures in last eight years.
If working conditions are bettered, even more patients can be helped.

Thanking you,

Yours faithfully

(Vivek Gharpure)

2007-10-06T19:51:00.001-07:00

2007-09-20T21:34:00.000-07:00

medical teaching occurs at various levels. accepting the bromide that one keeps learning, even a teacher is learning something while teaching others. however, teaching undergraduates and teaching post-graduates requires different attitudes, different methods, different emphases. for a subject like pediatric surgery when a teacher may have to teach mbbs students pediatric surgery as part of general surgery curriculum, and surgery post graduates the rudiments of pediatric surgery; and pediatrics post graduates the tricks of early diagnosis of surgical conditions; and rarely actually teach pediatric surgery to trainee pediatric surgeons. a tall order. different syllabi, different methods. a teacher good at teaching the first group may not be good at teaching the last group and so on. so comment no one;

there are no generalizations in teaching pediatric surgery. treat each group differently. since we are used to repairing a duodenal atresia in a 1.4 kg baby and then feeding him few cc milk; and next day perform a vaginoplasty on a prepubertal girl; we are used to modify our methods based on the patient's size and ablity to take. modifying our teaching should not be too difficult.

T: Think out loud

A teacher should show the learner the process, not merely the outcome, of expert reasoning. The teacher should explain the students at every step of approach to a clinical problem as to why a particular option is chosen. In this process it is inevitable that the teacher would also expose the students about his own missteps and judgmental errors. Many teachers do not adopt this because they must have enormous level of humility to accept their missteps.

a famous story about a medical student asking the patient whether he ate a horse after he saw the teacher ask another patient whether he had eaten mangoes would clarify the above situation very well. oftentimes our own reasoning is convoluted and based on what our teachers consiered good and bad. even the best teachers will have their dogmas. it is good to have opinionated teachers; this gives them personality otherwise we would all be identical. the process or clinical path is not always clear. intuition often makes us take shortcuts.

A: Activate the learners

It is contrary to the current policy of "shut-up-and-do-what-the-teacher-says". A Socratic style of stimulating students to ask "why, what, how" should be promoted. The teacher should merely stand by the side of student while he/she is making decisions or interventions like surgery. The teacher should however jump-in when the step taken by the student is harmful to the patient.

the student must do what the teacher says, because the teacher has the responsibility. every issue during a procedure can not be decided by consensus and committee. there may not be time enough to explain everything then and there. and it often irritates a surgeon when the student in all innocence asks 'whether the anastomosis will hold or what if the suture line leaks?'. it is good policy to do what is bidden and lateron ask very politely the great mind whether more information is available and whether other approaches are useful and so on. some teachers like their students to take a decision and ask before acting. others don't. what is important is to accept that a diagnosis may be wrong and there is no shame in it. this fear of being ridiculed or being hauled up by the teacher for writing a incorrect diagnosis on the casepaper; which prompts many a residents to write diagnoses like 'abdominal pain or abdominal lump' on the case paper.
L: Listen smart

When the student presents a case during ward rounds, the teacher should actively listen to that. That means the teacher should have examined the patient beforehand to cross check what the students present is true. In short "assess the patient before assessing the student". This requires the teacher to become a perpetual student and take history - do physical examination as it would be done by a student. Again this requires humility on the part of teacher.
in pediatric surgery, formal case presentations are quite rare. the diagnosis is usually obvious even to the mother. the real difficulty lies in confirming the diagnosis, assessing the seriousness of the situation, preparing the patient for surgery and performing the surgery. take situations like spina bifida, anorectal malformations, hernia, hypospadias, undescended testes and so on. rarely we need to do a formal examination like described by 'Das'.

and listening should include listening to the mother who often gives the best information. without a proper 'F.I.R.' how can we expect the investigator to proceed? listen to the mother. one will have to learn the dialect and understand local slang for baby's bodily functions.

K: Keep it simple

The teacher should simplify complexities by concise communications and should promote rule based decision making. Reductive principles should be used to draw generality. (Eg: All bilious vomiting are of surgical cause unless proven otherwise while non-bilious vomiting is mostly of non-surgical origin)

W: Wear Gloves

Promote hand-on doctoring. Student should be encouraged to arrive at a bed side diagnosis and decision irrespective of how it is modified later when investigation results are available. This means practicing clinicians will be better teachers than researchers and administrators. Unfortunately, bedside teaching is slowly going out of vogue. Students now depend more on chest X-ray or CT scan than on auscultation.
there is no argument about this but where is the question of wearing gloves? why wear gloves while doing auscultation? washing hands is simpler and cheaper.
A: Adapt enthusiastically
When something goes unexpected, consider it as the greatest opportunity to learn. Encourage student to handle clinical uncertainties more enthusiastically. This require the teacher to admit his errors and to accept that many clinical problems lack evidence and are still a dilemma.
'clinical problems lack evidence' is difficult to understand. the cause of many clinical problems is not known. we are stumped after about three 'why's. to take an example.

the baby has constipation

why

he has congenital megacolon

why

there are no ganglion cells in the intestine

why

they did not migrate

why

no answer.

that should not stop us, the clinicians from treating the patient. our job is not to find the cause of most of the illnesses that we treat. we may stumble upon it in our lifetime and then we would be very lucky. our job is to make a correct diagnosis, select the treatment best suited to treat the illness and actually carry out the treatment. not a small order.

on top of it, if the patient you to tell him the cause of the illness, one might excuse himself.
L: Link learning to caring

Show and expect of learners, empathy and responsibility for each patient. In other words students should be taught to understand the patient's illness as well as their disease. But the problem is how far this is feasible in today's era of medical consumerism.
does is not take away the detachment necessary for a surgeon by taking more interest in the patient's other affairs? great attention to technical issues is required and i believe it is better not to be distracted by irrelevant issues.
K: Kindle kindness

Establish generosity (not politeness) as the standard for all clinical interactions. Encourage the students even when offering hard criticism at their actions. Treat the disease as enemy but the patient as a friend.

robert louis stevenson, (the author of kidnapped and treasure island) was a medical man himself. he has written a short essay on qualities of a doctor. he says, that patients should not try to findship in the offices of doctors. there are other places and other people who can become friends. if a patient should happen to become your friend, good but don't treat patients hoping that they will become your friends. i agree with stevenson.

regards

vivek gharpure
aurangabad,
india
431001
00919423781537

result

2007-06-28T09:29:00.000-07:00

suparna scored 93.84% in ssc. a good beginning. performed even better than ketaki. we were worried if he was under some pressure to perform but it seems he handled it well. all through the year, he continued to read fiction, bill bryson, and other books. which was probably good. this morning was spent in getting admission to deogiri college. met vakil's son, supekar, jewlikar etc.
vidya and jyotsna left this morning. rigved, irawati, ashwini and children leave tomorrow. then things will settle back to routine for a while.

age

2007-06-28T09:28:00.000-07:00

there was a time when patients were older than me. when i joined pediatric surgery, all patients were younger but parents used to be older. then parents were younger.
now it seems that even grandparents are getting younger.
such is life.

management

2007-06-28T09:23:00.000-07:00

indian institute of secret management will hold classes on
1. how to arrange shootings, rioting, bawal
2. how to adulterate petrol with kerosene
3. how to grab land
4. how to evict people
5. arson
6. match fixing

operations

2007-06-22T20:26:00.000-07:00

of date, i have performed more than 800 surgical procedures in the government hospital. even if i could have charged rs.5000 per procedure, i have donated almost 40 lac worth of my time to the benefit of poor patients. it is so satisfying to do work for the indigent. i hope almighty god takes notice.

work

2007-06-22T20:22:00.000-07:00

why is it that people don't want to work but just want a job? which pays good? i used to employ 10 people and there used to be absenteeism. now i have removed four of them and still people continue to remain absent without leave. has evreryone become a millionaire? how can we run a service organization without people? they are paid whatever they want, they are paid on time, they are given plenty of leave, hours are not strenuous, still very few want to work. very few work diligently. and they all have big egoes and very sensitive sentiments which get hurt if you utter just one harsh word. i am getting sick of trying to run a hospital and perform operations. the same situation in government hospitals, private hospitals, trust hospitals, intensive care units. how are patients going to get good medical care? god is great.

neonatal intensive care

2007-06-17T19:45:00.001-07:00

do we really need neonatal intensive care for surgical newborns? in last seven years, i have operated on not less than 200 newborn babies and they have not received one iota or neonatal intensive care in the government hospital. no isolation, no trained residents,no trained nurses, no monitoring, no investigations. despite odds, a large number of them have gone home. do we really all the paraphernalia for all patients? i guess not.

violence

2007-06-17T19:45:00.000-07:00

indian society has become so violent. every day one reads about riots in some part of the country. one wonders whether indian civilization is really 5000 years old.

assistance

2007-06-16T05:48:00.000-07:00

i seem to be saddled with the juniormost resident. it was allright initially but these days, this is causing some difficulty. the assistant does not know how to cut ligatures, how to pass ligatures, how to retract, how to mop. and on top of this, he is expected to assist in major surgeries like urethroplasty, esophagoplasty and so on. i refused to operate without proper assistance this morning. i hope i get better assistance next time. no equipment, no instruments, no assistance, no order, no salary. why do i continue to work? have i paid my debt to the society? to my college?

age

2007-06-16T05:44:00.000-07:00

grandfather came to see me and tried to touch my feet for helping his granddaughter. i stopped him just in time and said that he was certainly older than me. then i asked him his age. it turned out that he was four years younger than me.
all my patients are younger than me.
off late parents of my patients were also younger than me.
now i find that even grandparents are younger.
i am certainly a old old person.

re:account

2007-04-17T06:14:00.000-07:00

met this gentleman who wanted me to do this operation on this girl without
allowing me to see the patient. just seeing the barium films is not enough
to make a correct diagnosis. when i asked to see the patient, the gentleman
has disappeared as expected.

serials

2007-04-17T06:01:00.000-07:00

why hindi serials have sound effects? they are slower than a geriatric snail. yesterday was very difficult. no electricity for 12 hours and no water for nearly 6 hours. how do we manage? somehow. met two patients who appeared very grateful. made my day. this is what keeps me going.

2006-12-28T06:32:00.000-08:00

                   iBB   BB                      aa
                  ii       B                     aa
                  ii        B                    aa
                  ii        BB
                  ii    BBBB BB
AAAAAA AAAAAAiiiiiB BB B Baaaaannnnnnnnnnnnaaaaadddddddddddddddddnnnnnnnnnnnnaaaaa
AA    AA   AA    ii BB    B     aa               aa           dd                   aa
AA      AA AA    ii BB    B     aa               aa          ddd                   aa
AA      AA AA    ii BB    BB    aa         nnnaaaaa        dddd              nnnaaaaa
AAA    AAA AA    ii   BBBBBBB    aa      nnnnn    aa     ddddd             nnnnn    aa
A    AAAA AA    ii        BB    aa     nnnnnnn   aa    ddd   dddd        nnnnnnn   aa
     AAAA   AA    ii        BB    aa    nnnnnnnn   aa   dd    dd dd      nnnnnnnn   aa
     AAAAA AA    ii      BBBBBaa aa   nnnn   nn   aa   dd    dd dd     nnnn   nn   aa
     AAAAAA AA    ii    BBB BB    aa   nnn    nn   aa   dd   dd   dd     nnn    nn   aa
         AAAAA    ii   BBB BB    aa   nn     n    aa    dd dd ddd     nn     n    aa
   AAAAAAAAAAA    ii   BB   BB    aa   nn     n    aa     ddddddddd      nn     n    aa
AAA     A AA    ii   BB BB     aa    nn nn     aa       ddddd         nn nn     aa
AA      AA AA    ii    BBBB      aa     nnnn      aa         d            nnnn      aa
AA     AA                                                     ddd
AAAAAA


















vivek gharpure

re:pain

2006-12-28T06:09:00.000-08:00

i have been having spondylotic pain for the last three weeks almost and this
has been a great education. i never believed that pain can be so bad, so
excruciating, so agonizing. i learnt the meaning of restlessness, anxious
look. i decided then and there that henceforth, all my operated patients are
going to receive analgesics round the clock and i am not going to exhort
them to get up and get about.
it was also sobering to learn that a patient does not know what is wrong
with him, whether it will become all right, when it will become allright.
knowing fully well the etiology, etiopathogenesis, signs and symptoms,
progress of cervical spondylosis, i did not what to do.
i learnt that it is possible to take too many analgesics for too much time.
i have experienced how it is like to sit up half the night and still try to
do things the next day.
i have realized how and why patients are anxious. they are scared to death.
the fear of pain, fear of suffering, fear of death is the greatest fear of
them all.
i also learnt that for a patient in chronic pain, it becomes very easy to
believe that homeopathy, accupuncture will make him right.
i even was willing to try the 'nas remover', reiki. whosoever made me well
was a good doctor. this after having been a doctor for nearly thirty years.
it was sobering to see the sideeffects of benzodiazepines. sobering to
realize what people are going through.
sobering to learn that some illnesses will never go away whatever you do.
when i pronounce to parents of a child with spina bifida that he will remain
disabled for life, they accept with eqanimity, at least they pretend.
now i know.
now i have learnt the close connection between physical symptoms and mental
states. under pain, i could be very depressed, with analgesics, i could be
manic. it is so easy to have a misunderstanding when someone does not smile.
quite possible he is having cervical spondylosis.
it has been a great education. i am surely a better doctor for having gone
through this.
vivek gharpure

re:consumer law

2006-12-17T19:42:00.000-08:00

all that the consumer protection act does is to lay down the procedure for
filing complaint, filing appeal and so on. it says very little about what is
a deficiency in service. so the trial of fact is done on common law and not
statutory law. only the procedure is based on the consumer act. there lies
the rub. if it is a trial by common law the common law principles should
apply. they don't.

vivek gharpure

re:hero worship

2006-12-07T18:42:00.000-08:00

Dear members,
Dr ravinthiran has written in detail about his feelings and why he believes
them to be correct. Respecting his opinion, I will try to answer some of his
statements.

Prof Upadhyayas contribution to spleen conservation is a great idea and has
saved countless number of spleens. Upadhyaya shunt has helped many babies
with hydrocephalus.

Prof Pena has glamour and who does not like glamour? One is excited if
Sachin Tendulkar or Aishwarya Rai was to sit next to you.

Dr Snodgrass visited Aurangabad some time ago. During a dinner in his
honour; he spoke on his technique. After meeting Snodgrass in person, I felt
like Eklavya meeting Dronacharya; but Snodgrass was kind enough not to ask
me for my right thumb.

Meeting such individuals in person is a great experience. One always wonders
what exactly the author means by a particular sentence. Would it not be
wonderful to listen to Thiruvalluvar himself speaking?

Some of our political leaders are not known outside the district, some not
outside the state, others not outside the country. Some of our gods will not
be known in other countries. Prof Pena or Dr Snodgrass are known all over
the world. They are immortal. It should be the ambition of every surgeon to
have an operation or an instrument named after him. These gentlemen have
achieved it.

As Andy Warhol has said, everyone is entitled to 15 seconds of fame. These
individuals are certainly entitled to more fame and glory. Why begrudge them
their limelight?

Galens dogmas persisted because the formal belief in book. After Francis
Bacon and the advent of scientific method, no one really believes everything
in any book. Such fears are unfounded. If PSARP did not work in the majority
of individuals, the procedure would have been given up long ago. The fact
that is has survived for nearly 25 years, in most of the countries of the
world says enough about the satisfaction of majority of surgeons about the
procedure.

Ambrose Pare used ligatures instead of cautery when cauterization meant
dipping the amputation stump in boiling oil. Electricity as we know today
did not exist during the times of Ambrose Pare. He could not have dreamt of
electric cautery.

Disregard for embryology or physiology has not stopped PSARP from being a
very practical operation.

A little about history.

Textbook of surgery by Michener and Romanes nearly 50 yearl old has nothing
about imperforate anus. No diagnosis, no invertogram, no colostomy. The
subject is not mentioned at all. There are about 70 lines on megacolon ; and
120 lines on visceroptosis (?).

The 12 volume Lewis Practice of Surgery too is silent on the subject of
anorectal malformations.

Stephens book on anorectal malformations describes the anatomy of levator
ani. Subsequently the following statements are made

1.internal sphincter could not be dissected and identified in male patients
with rectourethral fistula and in female patients with rectovaginal fistula.
2. internal and external sphincters in patients with anorectal malformation
were of negligible value and levator ani provided the main sphincteric
mechanism for continence.

Stephens description of the sacrococcygeal approach reads almost like Pena
s description.
The steps are;
a. position is jack-knife
b. midline incision in natal cleft
c. coccyx is separated from the sacrum
d. pelvic rectum with fascia is seen
e. rounded end of rectum is incised to expose the fistula, which is ligated
and divided
f. detached rectum closed and mobilized by finger dissection
g. right angled forceps used to define the sling close to urethra and the
space used to bring out the rectum which is then sutured to skin.

So we can claim that Penas procedure was described by Stephens in 1953.

Stephens also states that

It is remarkable how a severely damaged and weakened levator ani muscle
when intelligently used can be made to work

The second edition of text book of pediatric surgery does not find a
mention of PSARP.

The chapter mentions that;

factors causing incontinence may have nothing to do with the physical
ability to control the fecal stream; and functional results achieved in
correction of anorectal malformations are more closely related to the
anatomy presented to the surgeon than to the choice of operative procedure.

Then we have the chapter on surgery of anorectal malformation in SCNA Oct,
1985, written by Pieter de Vries and Kenneth Cox.

de Vries goes about describing the various views on anatomy of pelvic
muscles . he gives a table showing height and width of sphincteric muscles.

He states that the puborectalis is no greater than the deep sphincter; where
puborectalis goes around the rectum.

Wilson who dissected many fetuses states that
Fibres of puborectalis interlaced to a very great extent with deep fibres
of external sphincter. The sling of puborectalis and deep sphincter forms
almost an indivisible muscle mass. The sling may be predominantly formed of
puborectalis or by the external sphincter. I have found that the external
sphincter usually predominates.

Bodenhamer described the Posterior Sagittal approach in 1860!

The 1984 issue of Current Problems in Surgery written by deVries; is a
great monograph with 171 references; and covers the history of study of
anatomy of anorectal malformations, attempts at repair, theories of
different repairs, a brief description of stephens/kiesewetter technique and
pena/deVries technique.

He also mentions two procedures which were described in 1982, viz
Sacroabdominoperineal operation with double skin flap described by (Millard
and Rowe); and Abdomino-sacroperineal operation with smooth muscle
musculoplasty (described by Holschneider-Hecker and Hofman-koltai). Millard
procedure tried to solve the problem of mucosal prolapse but does not seem
very popular today. What happened to the other procedure? Is anybody still
doing it?

DeVries ends the monograph with this statement,
A historical review of surgical efforts to correct anorectal deformities
leads one to the impression that progress has taken a more or less helical
course, inching forward slowly in the long run, but sometimes appearing
circular. Knowledge in anatomy, or physiology and the procedure of their
predecessors have often escaped the attention of surgeons.

There is a pressing need for further evaluation of the functional results of
several older and newer operations being performed for correction of
anorectal defects, particularly with high and intermediate anomalies. The
use of objective, quantitative assessment of function (bowel motility and
compliance, volitional and reflex sphincter contrations and sensation)
within the framework of a consensual standard classification is lagging far
behind the enthusiastic adoption of new operative procedures.

In the absence of valid, comparitive data on postoperative functional
results, surgeons can only choose one or another operation on the basis of
other, collateral considerations or accept the rationale and claims of
greater success offered by proponents of a given procedure.

1. PSARP is a simpler procedure compared to Stephens procedure, or Rehbein
procedure, and certainly simpler than the Mollard procedure. Some of the
newer surgeons may have not seen the older procedures.
2. PSARP is less morbid than abdomino-perineal pullthrough
3. The procedure is soundly based on anatomy, and has a good inductive basis
4. It works in the majority of patients, with majority of surgeons using
routine equipment in diverse circumstances.
5. Till a better procedure is devised, surgeons will continue to use the
PSARP.
6. We need not comment on idiosyncracies of Prof Pena; he is entitled to
them. we may or may not use cautery as much as he does. we dont starve the
patient for 10 days, and never use TPN for transposition/Asarp; most of us
dont have colostomy cover.
9. Prof Pena is not ordering us to use his technique. If we are not happy
using this, we are at liberty to perform any other technique or devise a
newer and better technique.
10. Prof Pena does not demand a license fee from us for using his procedure,
there are no intellectual property rights.

Unethical use of photographs is to be deplored. But then we write our
degrees on our letterheads dont we. And we will also like to add aiims,
mumbai, chennai, UK, USA in brackets just to let others know that we are
associated with a certain reputed institution. We display our certificates
in the waiting rooms. Some of announce in lay press that they have presented
a paper in the national/international conference. Displaying ones
photograph with a eminent personality is only taking the practice a little
further; trying to get a little more respect. There are far worse things a
person can do.

I was keen to have my picture taken with Pena so I could show my daughter
that there are persons who have made a name on the basis of their ideas. The
example is certainly worth emulating.

I hold no brief for anybody.

On my return flight I met a group of visitors from Japan. One of them asked
me what I did for a living. Then he asked me about what operations I did.
When I asked him whether he had heard of great surgeons like Drs. Kasai,
Ikeda, Kimura, Miyano; he was ignorant of these individuals and their
contributions to pediatric surgery.

The public does not know about pediatric surgeons, and probably does not
care less. We know and we should honour these individuals for their
contribution.

Regards

vivek gharpure

vivek gharpure
children's surgical hospital
13, pushpanagari,
aurangabad,
india
431001
00912402332867
00919325212384

"hindsight is always 20:20"

pradnya, sheel, karuna

2006-12-01T19:22:00.000-08:00

the great budha recommended pradnya, sheel and karuna. the great bharatratna dr ambedkar exhorted people to educate themselves, organize themselves and then resist injustice. what is being done today by persons in the name of the great educator and constituionalist? is this india or lebanon? or some country in africa where gangs of people go about attacking each other? are we a civlized nation? the greated 'working democracy'in the world?

re:alberto pena's aphorisms

2006-11-20T05:48:00.000-08:00

1. bad surgeons become worse surgeons
2. surgery does not respect titles
3. surgery is like a cheap whore, you have to go more often
4. idiopathic constipation is not curable, but managable
5. carelessness in surgery is like scratching testicles of a tiger

re:x-ray machine

2006-11-17T23:12:00.000-08:00

the cop manning x-ray machine at aurangabad airport was able to locate the
batteries in charger and also where the charger was located in the bag. i
wondered if he could apply for the post of radiologist, he could very well
locate hidden objects and tumors!

vivek

re:preventive medicine

2006-11-17T23:00:00.000-08:00

new syllabus for preventive and social medicine
1. how to assess and evaluate paying capacity of patient
2. how to collect financial information about the patient
3. how to turn away patient who is not financially sound
4. how to refer a patient to government hospital after he has exhausted his
pocket
5.how to tranafer a sick/dying patient to icu and avoid post death trouble
6.how to maintain good relations with police, press, leaders
7.how to shift blame
8.how to involve many doctors in management and avoid responsibility
9.how to talk with nagarsevak, mla, mp, jillha adhyaksha
10. how to protect yourself from injury with special emphasis on
bullietproof jackets, chain armour, types of helmets
11. 37 ways to barricade your hospital
12. how to cook up records, fudge data, create misleading evidence
13. how to order unnecessary investigations to satisfy the patient
14.how to please the general practitioner and referring doctor
15. how to screw the competition

vivek gharpure
children's surgical hospital
13, pushpanagari,
aurangabad,
india
431001
00912402332867
00919325212384

"hindsight is always 20:20"

genes

2006-10-31T05:20:00.000-08:00

is there life on other planets? if the laws of physics and chemistry are universal, normal metabolic processes seem to be the most efficient way of generating energy from glucose. dna structure seems to be the most efficient way of transmitting genetic information. in which case, should life anywhere on universe be similar to life on earth? i hope richard dawkins does some research on this.

of the different classes of animals, do they include all the animals which exist and which may have existed? is it possible that a complete class of animals became extinct? what about plant classes?

diwali

2006-10-26T20:26:00.000-07:00

why is it that the charm has gone out of diwali? it has become a ritual without any deep feelings? age? but then children are also not moved by the festivities. the palate has become jaded.

pig

2006-10-14T06:42:00.000-07:00

saw a big pig rubbing its back against a tree while going to the ot this morning and remembered the story about the king, pig and barber and started laughing. public was curious as to why this gentleman is laughing out loud looking at the pig. i had never seen a pig rubbing its back. a cat yes, a cow sometimes, but a pig never. well if the king could see a pig from his balcony, just goes to show what kind of king he was.

did a pericardial window for a young adult with tamponade this morning. the patient was refused by general surgeons and physician was kind enough to ask me to put my finger in it. went off well. i hope he does well over the next few days.

re:tv watching

2006-10-12T19:16:00.000-07:00

why do people (including me) watch tv aimlessly? is it akin to watching a
campfire?
does a tv signify a burning fire in the hearth which was essential when men
lived in caves?
in which case, what did people watch for the last 10,000 years when tv did
not exist?
?

re:

2006-10-11T04:50:00.000-07:00

met a senior retired teacher in the morning. he reminisced about how he has
helped so many hundrends of persons while in service and how he has been
honest and non-corrupt.
he had few things to say about administrator and was particular about how
the lady should not try to do everything herself.
well!

2006-10-11T04:45:00.000-07:00

sticking plaster is used so often and in so many places, it is as if it is the eleventh incarnation of vishnu.
the diathermy pad does not work unless a weight is put on the cable. typical of a 'sarkari' equipment which does not work unless some 'weight' is put on the file.
most of the serials seem to be consisting of few, ie less than 10 lines of dialogue filling 22 minutes of serial time. the background music continues from the first sequence to the last. why does the writer economize with words?
and religious refrains are in fashion. almost every serial has a theme 'prayer' which is repeated in every episode.
is there some superstition involved? is the writer trying to regulate the number of words exactly? is the number of words in an episode a fibonacci number? can the sequence be found in the digits of pi?