MUNI-Mindedness

There are too many things going on. I start interviewing next week. I have been waiting for this for 2 years.. the wait has made me very enthusiatic about the new prospects, a tad bit apprehensive and paradoxically a little unfocussed. I have a exam coming up, I am also going to the Liver Meeting (I attended it last year, and would like to attend it every year for the rest of my life.... live updates at the end of the month!). I reiterate there are too many things going on!

So, everytime my mind wanders I will write a post on where she goes visiting! Today, it is MUNI, his quaintness, idiosyncrasies and very personality.

I travel the San Francisco MUNI everyday. I am a true fog city denizen: MUNI Rider, exotic food sampler, dresser of layers, random walker, lover of The Bridge and not of California! Traditionally all Bay Area emigrants are Yuppies! Can't really call myself a yuppie. Upwardly mobile: if I match. Entrepreneur: Dude, I have at least 6 years of education left. Let's have a normal amount of perspective here!

The MUNI has four oft used avatars..all his forms weird and lovable in their own ways. The Buses, The Light-Rails, The Street Cars and of course The Cable Cars. The Cable cars are the oldest : in concept and maybe production. But they are like little brothers. They are pampered, expensive to maintain, often throw tantrums (breakdowns all the time!), always forgiven when late and above all loved by everybody who meets them! There are two lines of the cable car that originate very close to my tiny apartment. I take the Cable cars when I am little sad , little lonely, little crazy or totally random! The Cable cars can cheer anybody up. All the jerks, the innumerable stops and the cold wind ignoring all your layers are forgiven. The spectacular views and sheer joy of living they have makes up for its shortcomings.

The vagaries of the N-Judah are legendary. The N-Judah is one of the light-rails. She has 4 more rickety old ladies for her cousins. They are a group of hags that huddle around Embarcadero once in a while and take forever to make their round trip. Almost everybody thinks they should retire and ask their more robust cousins to come to Frisco. However, they go on with an amazing perseverance, chugging along, not really caring about what people think. The N-Judah is the one I take most frequently, all the way to the doors of UCSF. She almost never comes on time; particularly when you have a meeting. She is dirty, in need of care, over used and pretty much the only one that cuts through the city and goes to Ocean BEach on that route. Sigh! Unavoidable Miseries. And wait till it rains, the joints will creak and jam, the dexterity will reduce, the roofs will leak and the old ladies will apologize profusely for their profound inadequacy! Sometimes they even bump into each other...

Then we have the Street-Cars. Robust ol' fellahs..Desire is indeed their middle name! The Street-Cars again start their route near my home. They come from all over the world, slightly arthritic with a few center-of-gravity kind of Parkinsonian jerks, but surprising fast for their age. They do an excellent job every weekday chugging along, allthe way to Castro at a decent speed and a delightful old-world charm. But best avoided on weekends, that is when every visitor of Frisco decides at the same time: 'we should take the F-Line (popular name for the street-cars)!. The Old Bones can't really take all that stress!

And finally.. drum roll...The Buses!! Every Bus carries a bit of the city in himself. He is all touristy at times with Australians and New Zealanders in Summer, the American Out-of-Towners in spring and the whole world in Frisco's fantastic warm Fall. Sometimes he carries a bit of China in him as passes through Chinatown or a bit of Mexico in the Mission. The 10 has a world of its own: laptops, aftershave, fashionable pumps, lunch totes and iPhones. The 10 cuts through FiDi. The Buses have their regulars. Over the year, I have my Bus-acquaintances. People who travel the lines regularly and I see them very frequently. My life falls into a pattern and it is in-step with strangers whom I know nothing about. And we see each other every day and somehow relax a little with the realization that everything is in place.I see the lady in the North Face Jacket who shops religiously at Whole Foods Market, I think she is German. Or the platinum blonde erstwhile hippie, always dressed in a bright pink tattered wool coat and red sandals; I think she works in Richmond. The partially blind incredibly perceptive young man with curly brown hair, who probably once had full-thickness burns on at least 50 percent of his body. The Japanese lady with her upper lip shaped perfectly like Cupid's bow; her daughter appears to have Down's and so do many other kids who take the route at that time to what I believe is school for the Specially abled. The African American Grandmother who takes her grand-daughter to school everyday. She has been on a wheel chair lately and it distresses me! The Gujrati man from Kenya, he always has a tweed cap and I wonder how the top of his head looks! I think he is a diamond trader!! The Sardarni from Jalander, who can speak only in Punjabi but always wishes the driver a good day. The Middle eastern driver who stops for me even when it is not a bus-stop. I can probably go on and on!

The Buses have become a part of my life but they have a life of their own. They have scant regard for traffic rules and at times the strangest people are their patrons. Not so long ago, this happened on a route I frequent.

http://www.youtube.com/watch?v=nx6FRSemW38
Hmmm.. I am a bit careful these days. I avoid that route at times. But it also means avoiding all those people see everyday. Anyone can have seat...seriously :)

Spotlight!

A friend of mine recently underwent the resection of a benign pituitary cyst. When I had first told about trans-sphenoidal surgeries (endoscopic surgeries through the nose), he was completely incredulous. I followed him through his various states of disbelief, from diagnosis to post-resection. Two weeks after his operation, I was glad to see him perfectly hale and hearty. We had a good laugh as he described what went through his mind on the day of the surgery. It is hard to be a patient, I guess. My father underwent a cholecystectomy (gall bladder removal) a few months back. He removes at least 4-5 gall bladders a week. According to his surgeon, he had 20 suggestions, till the anesthesia knocked him off! I wonder what Dad was thinking. I bet thought of everybody ..from Kocher to Gall!This is what M was thinking..

As he lay waiting for his surgery in the oh-so-severe sterile light of the waiting room, M was thinking of lots of things. Dr. K had returned from a wonderful vacation at Europe. What if...what if... he left his skill at the golden sands of the French Riviera? Just hypothetical, but what if? What if he comes, drapes him, sticks the endoscope up his nose, and says he does not feel like doing it today? Will he lie down here another day, thinking of hypothetical situations again? Will insurance cover this day? What about the drugs? He has to take leave again... Oh no...that would mean no more PTO, no India trip this year..Oh well.. lets think a little differently. California is so prone to earthquakes. What if just when the snare grabs his cyst, there is an earthquake measuring 9 on the Richter's scale? And the fateful shake of Dr. K's hand pulls out half his brain. May be one fourth.. well more than required, what function am I going to lose? Is everybody going to leave the room after the earthquake with the endoscope sticking out of my nose? What if the anesthesia wears out? What if they give me too much of it? What if they cant take out the tumor and they have to drill through my skull? Where would they break my head? With what ? Chisel and hammer?? Oh Gawd... electric saw? How would they cut the scalp? Will I have incisions like Aamir Khan in Ghajini? What about Short Term Memory loss? What if I forget things? What if I don't remember things? What is my wife doing? What about the actual things that Dr. K said that could actually could happen. I am reasonably sure he cannot predict earthquakes. Blood transfusions? Why?? Will I be on hormone replacement for life? What if it grows back? Another surgery??

Well here's my turn! White lights, big white lights. When I close my eyes I can see UFOs. Open eyes. Big white lights. Close eyes. UFOs. Yes, I am M. How am I doing?? What do you think Ms. Nurse? How would you be doing if you know they are going to pull a piece of your brain through your nose? Oh that's the anesthesiologist. I hope he knows what he is doing. Has he done this before? How many times? What's that white stuff in the syringe. OH MY GOD! That what Michael Jackson died of. Is that what it is? What did the New York times say about that drug? Something with P, I think. Did he just say that we are going to put you to sleep? Wait a minute. May be I should ask him whether the drug is safe. Is there any substitute? Billie Jean... Home... My wife... little sleepy...

*%$#! The pain! My head! Its screaming. The lights are a little bright, recovery room I think. I better close my eyes. Am I going to puke? Oh yes I am. Stop slapping me, you.stupid nurse.... I am alive and slapping me is just not going to anyway help. Yes I am M. Where am I? Is this the time for this? Somebody get me something to vomit into. I will just lie still. And please, somebody make this nurse shut up. The time? How audacious. Can't she just see the clock? She wants me to tell here the time? 3-4 in the afternoon I guess.........aaah,< puke puke ..puke>... Good God! My head! .... I want to sleep.. when do u get me out of here... Clearly, not now.

It took him a week to feel better. Walking to the bathroom was like climbing Mt. Shasta! He took painkillers with morbid fear. Dr. K. had almost convinced him that more than 2 tablets and he will need a liver transplant! It had taken some amount of explanation that he needn't writhe in pain for the fear of a liver transplant! He feels fine now and has started working almost as hard as ever, to his wife's dismay. He had new views on the need for health care reforms. The cost of the surgery was S132,000 which he is still not able able to believe. Thank goodness for insurance!

The Unbearable Inertia of Being

There is an inertia in everything I do. For starters, when I get up in the morning, irrespective of the time I slept, I need 5 minutes more (more often than not 5 minutes here can be up to 30 minutes; depends whether it is a weekend or not). There is different kind of inertia when I comes to write blogs. It can always wait for 5 minutes more (more often than not 5 minutes here can be up to 6 months!). Does that mean that now that I am writing this post, I will tend to write it for a long time? Maybe not.

The inertia of rest is what is unbearable these days and dominates my life. The presence of inertia of motion has not yet been detected, though there is definite sense of yearning. There is lot of peace in doing nothing. I am trying to wonder aloud: what happened? Where was it that I went wrong? There used to be a time; where there was a need for 10 things to be done at one time, a need for anarchy. These things often included 10 chapters to be finished from 10 different subjects! Nowadays I have deadline, but I can't study. I have stopped seeing the awesomeness in random trivia. It does not interest me anymore, that the technical word for hiccups is singultus. Heck! why bother, I will never use it anyway.

This blog is now a therapeutic effort to revert back to normal; an effort to see awesomeness in totally random things again, an effort to get back that anarchy I used to call life :)

P.S. Gawd! I miss the hospital !

Delhi 6

I lived in Delhi 18, went to schools in Delhi 58 and Delhi 22, hospital in Delhi 1 and still do most of my shopping in Delhi 1 and 27. However, I had never before referred to Vikaspuri, Janakpuri, R.K. Puram, Connaught Place and Rajouri garden by their pin codes. I saw Dilli-6 yesterday, where everybody referred to Chandni Chowk as Dilli 6. I think if I tell the auto-wallah to take me to Delhi 6, I think he d say “O Maaaadam, naye ho kya…kaunsi jagah jaana hai ..Sonia Cinema? (O Madam, Are you new here? Where exactly do you want to go …Sonia Cinema?)”!!!

Before the onslaught of multiplexes in Delhi, the innumerable PVRs, we used to have normal theatres: Sonia, Payal, Priya, Anupam etc. , all of them are now PVR. But the auto-wallah, the bus driver and the rickshaw- wallah will still call them by their original names. Near PVR Naraina, the bus stop still says Payal. Similarly Connaught Place is still called by its erstwhile name and not Rajiv Chowk. RML hospital is Wellington, LNJP Hospital is Irwin and AIIMS is Simply Medical. But Chandni Chowk has never been Dilli -6!

Delhi-6 to me meant a yearly excursion to Chandni Chowk for my textbooks. Little shops, I think just about the size of the kitchen in this studio apartment line ‘Nai Sadak’, a famed by- lane of Chandni Chowk where you can find every medical book printed in English (at least). Nai Sadak literally means ‘The New Road’. The new book is however just one of Nai Sadak’s specialties. Books that have exchanged hands once, twice, thrice to those that have been around for a few decades are all here. So are Xerox copies, pirated copies and cut-and-bound copies! I once saw an old, but well-loved copy of Boyd’s “Pathology of Internal Disease.” It was a 1940-something edition. That’s where he would have written “Rheumatic Heart disease licks the joints and bites the heart”, something even the dumbest medical student in India knows. I guess Boyd had two great loves: English and things that “blew life’s little candle”!

It would appear that the shops at The Book Market have no walls. The shelves that line the wall would be packed with books, vertically and horizontally and somewhere there would be a ladder that would lead to an attic. The attic I believe has floors to store hundreds of volumes on medical sub-specialties. That is where one would find Kaplan’s Cardiac Anaesthesia, William’s Endocrinology and the likes. The shop typically has the owner, who probably graduated in commerce (through correspondence), his aging father (who bequeathed the shop to him) and a couple of shop boys. Any boy, who works in any shop in Delhi, is called Chotu. Chotu 1 stays up in the attic. And let us say you ask for Rook, and lo behold as if by magic four huge volumes of dermatology would descend from the attic, into the owner’s perfect grasp. The standard digests of the medical student, the Ganongs, Harpers, Robbins and Shaws, were generally within his reach. And if by chance he doesn’t have a book you asked for Chotu 2 will run around and just find it from somewhere. Then, you would need to ask around in a few shops, to get a general idea about how much you can bargain for, bargain a lot and finally strike a deal after you get at least a 30 percent discount from the original price.

The Lange books got bigger and more colorful with every passing year. Katzung’s pharmacology changed editions so fast in my 5 and ½ yrs of college that I wondered how many drugs they added in these years. Coming to think of it, my edition did not have Nevirapine :). The pages of Harrisons’ got gossamer thin, and Bailey and Love was bluer than ever. The last book I bought there was First Aid to Step 2 CS for Rs. 350 ( after 20 minutes of good bargaining; to get the price down by Rs. 150) . It retails at $ 38 at the UCSF book store (and you cannot bargain there)!

Trips to Chandni Chowk before the Metro were arduous. As soon as you enter Delhi Gate, one of the gates of the Walled City, traffic just inches, as if jinxed. After almost two hours, at least two scratches on our car and after my Dad has used every expletive in his substantial dictionary, we would reach the sprawling parking lots of Red Fort. Finding parking is just a minor ordeal. Chandni Chowk has one main road and numerous by-lanes form a giant maze around it. Only a talented old Delhi cycle rickshaw wallah is the Theseus who can take us to our Minotaur!! Every by-lane (gali) has its speciality: Nai Sadak for books, Parathe Waali Gali for hot, fried parathe, there is one that sells clothes and one that prints wedding cards. My father’s destination is the one that sells surgical instruments. Every retractor, speculum, needle-holder and forceps ever created; catheters, cannulas, vacutainers, needles and syringes; trolleys and trays; tables and lights; they have it all. This is the only place where my Dad shops with the same fervor that I have at Macy’s before Christmas. Once, my Dad’s Maryland dissector refused to open its jaws. He went to find a replacement and came back with a few trays, an autoclave drum, an array of forceps and retractors and even green and blue linen. He was totally in the mood that day. He had this faint smile as forceps closed and ratchets made that sound that generally meant “secure” in his OT. That is when I managed to convince him to get me the maroon Littman :).

10 Stupid Things I did in college

1. Cried myself sore and stayed back in room, after I flunked the Physiology "Part Completion Test" (also known as PCT...duh) and thereby missed "The Grand Opening of the skull". (seriously how many times in your life do you open a skull with a chisel and hammer? Plus, I never had or will have intentions of becoming a neurosurgeon, or perhaps an African witch doctor!)
2. Fell in love with Biochemistry ( its okay if you roll up your eyes). It was just infatuation!
3. Hid from Dr. Venkatratnamma whenever I wore jeans.
4. Came (first), saw, and conquered the varicose veins case....totally uncalled for...all the tourniquets we tied and removed we could never figure out where the perforator was.
I even got him tomato bhaat from canteen.
5. Took notes in Dr. Srikantaya's class.....
6. Tried to study pediatrics from Nelson ( so uncalled for..) . My only achievement in pediatrics probably was mugging up and retaining fluid-electrolyte management. Considering I hoped to pass pediatrics with my internal medicine knowledge, Nelson was so not required.
7. Probably drank 8-10 cups of bitter, strong coffee everyday. Coming to think of it I drank more coffee than water and spend a small fortune on it.
8. Wore those ridiculous dresses just because I did not have to iron them !!!
9. Tried to have intelligent conversation in a Community Medicine class....(so hopeless).
10. College trips I undertook: to be counted amongst the most embarassing mistakes of my life.

The Dissection of Anatomy.

This is the most paradigmatic anatomy diagram. It would be in the back cover of 'foreign' anatomy books. There were a handful who tried to even read them, most sane people giving up in a month. In my opinion though, the most appropriate use for them would be weight lifting. 'Gray's Anatomy' is the most celebrated anatomy text. For those of you who are thinking when was the book on Meredith and Derek's romance released, Gray's Anatomy is a big fat boring book. Its a GR-A-Y and not GR-E-Y. if it is of any help. The height of hotness in the book is 'The Vitruvian Man' not McDreamy. In med school, no prof looks like McDreamy, most of the are more Nazi than Bailey. And inspite of poring through books all day and night, no one knows answers in rounds (unlike Yang and Izzie, who in four seasons have never studied, they have very laborious love-lives though)

The text which I studied and almost all medical students in India have studied is B. D. Chaurasia's Textbook of Anatomy. Small red volumes, three of them, just giving you what is important. I used to still mark the very important and when time is too short, very very important questions and read them. I would have never been Henry Gray's favorite pupil. Heck! anatomy didn't even impress me. For most medical students, anatomy is the First Year. Physiology (in my opinion a more conceptual subject) was a mere appendage and Biochemistry a distant cousin. Everybody loved anatomy; I loved a certain boy in my high school bus. Everybody has problems, I guess. Girls in particular ( always if the characteristics involved are weird, it must be associated to a girl). In my hostel, girls used to read anatomy in the morning, pre-prandial, post prandial, in evening and at night. There was no time in the day, girls in junior hostel would be found to be indulging in any mundane activity. The erudite lot studied anatomy, making Henry Gray twist and turn in his grave. My attention span with Anatomy was forty five minutes, and retention power was one day. why bother cramming so much, if I am going to anyway forget it anyway.

The cardinal part of Anatomy instruction is Dissection. We used to have two hours of Dissection everyday, after lunch, at two o'clock. At that time of the day, interest in education was grossly depreciated and what was required was a good siesta. The dissection hall didn't have stools, we stood all the time trying to read Cunningham's Manual. All volumes of the book should be included in non-pharmacological treatment of insomniacs. May be they should start a cohort study with the new batch. All of us were a persevering lot, always looking into the book, though never registering anything. The art of dissection was practiced in beginning of chapters. We used to dissect so wonderfully, that nothing was left to study, no nerves, no arteries, no veins. Gradually, love stories blossomed and idle talk increased, interest in dissection as a process became sporadic (very much like my posts). There were academic high points though: study of the mammary tissue (distributed to all tables with male bodies, like gurudware ka langar), study of the eye (cow's eyes provided for better understanding; likened to my friend Divya's eyes); the grand opening of the skull (which I missed, because I was crying in my room when I flunked physiology. Hey! even I am a girl) and maybe study of the male external genitalia (somebody stole a testis; as if he could attach it!).

I somehow passed Anatomy, by making 'colorful diagrams' in theory and by blinking rapidly and occasionally making an intelligent statement in the viva. I do not have to go to Anatomy class in future, I fervently hope.