Saturday, March 31, 2012


  The reincarnation is the only thing that can explain the 'bad ' things happening to 'good ' people and 'good ' things happening to 'bad ' people.  If we consider the God to be 'just' or 'merciful ' then how can we explain these things otherwise . When we see around us we find that not all bad things or bad people getting 'punished ' . So how do you explain it?. The question comes , if we have lived another life in past , how come we do not remember it at all. I have personally seen some one , who was mentally challenged , ( who could not have made up the story as did not have enough intelligence to create the false story. ) who repeatedly stated that ,( where he was living since birth ) "it is not my home " . On questioning as to where is your house, he gave a zip code and and the description of the house , where he lived . The parents did researched and found out a home of a priest, 700 miles away, never before visited by this kid or the parents, and it was exactly smiler to the one described by him . The reason for this is that the storage of these 'impression ' is in the abstract form and not like we have in this life . So now the question is , 'we have so many things that we think see and do , and come across hundreds of people in our life time , how do we 'store ' these memories in the astral body . ?' The answer is , " same as we do in this life.  "If I see  some one  only once , I am not likely remember him , in the future if I meet him again . But if have high school friend that I spent 10 years seeing him daily I will remember him , even if I meet him 10 years down the road . So the 'impressions ' are deeper when the contacts are more. So these impressions will come out in next life . Now remember when we deal with people we have 'give ' and 'take ' relations . We create 'debt' and we create 'bonds and attachments . These will bring us together in next life , and next life and so on , until we have dissolved all the bonds and all the 'debt ' is fully paid off. Then and then only we will not have repeat contact . If our contacts and bonds and impressions are small and short , then the debt is paid quickly.
    So now the question is , if our 'this ' life is predetermined , then how can we be held responsible for the thing that we do ? The answer is kind of mixed . We can divide the life and the things that will happen to us in 3 categories. 1 the things that we can change with very little efforts, 2 The things that we can change with  'lot ' of efforts and 3 The things that we can not change , in spite of lot of efforts . Also remember that we have free will . So because of the deeds in the past life , we will have the situation  that are 'pre determined '. But how we react to the situation  is up to  us . One simple example will simplify this . A husband goes home , finds his wife in the bed with his best friend. So this situation was bound to occur , but how he react is up to him . He can walk away, and send divorce her, or kill the wife and the her lover or he could commit suicide . In fact the collection of these deeds that we carry and that are going to come to 'fruition ' in this life determines our life span --duration of our existence in this life . when all the things that have to come to fruition this life , have occurred , we die. . just like the 'annual ' plants , once they have had the blossoms they  die .
   One more point about the 'law of the karma , ' and the reincarnation . Out of 4 levels of the 'life ' or the existences in this universe. The 'stone ' and the 'plant ' kingdom do not have their own decision making ability, and so the law of karma does not apply . In the 'annimal ' kingdom ' this is applicable to very small extent as the animals act on 'instict ' and do not have ability to make decision . So this is applicable mostly in 'humanbeings ' only.  
    How our lives are interrelated  will be discussed next time.

Friday, March 30, 2012


   The most interesting part about Hinduism is the concept of reincarnation. We talked about the 3 bodies including the astral body and the function of various bodies.It was noted that the  impressions in the abstract forms are stored in the astral body , and when the 'new' life starts, these impressions are carried in next life . They tend to manifest in this new life. This idea can be explained in little bit detail.
    When there is formation of Zygote , when sperm meets ovum , there is some indirect signal in the astral world. This attracts some souls. This is like matching game . we see this in e Harmony or medical residency matching. The medical students apply for the residency through computer, and then the hospital programs which are looking for the new residents  also look for particular characters. Now after the interviews etc , the students give their preference in the computer and the hospitals also give their preference. The computer does the 'matching ' and then the students are matched to the 'wright ' hospital. The birth of new life is very similar to this . Based on the 'pasr karmas' of the parents , only certain souls are attracted to the fertilised ovum. The souls that are attracted to the fertilised  ovum has certain 'past karmas ' that match, with the the karmas of the parents  and so it enters the zygote. The question arises as to when does this happen , is it with the fertilization or with the neural groove appearing, (as the causal body is inside the spine ) or is it when the heart beats start. I don't know . This question arises in the modern days where there are fertilised ovum kept frozen for the future use.  These are kept frozen sometimes for many years. So are the souls trapped in it ? Or since these are at very early stage , there is no neural groove so the soul has not yet 'entered' , the fertilised ovum. And what about the mono zygotic ( identical )  twins  'When does the soul enters? Since there are 2 separate souls in the identical twins, I feel that the soul enters when there is neural groove. In the beginning the fertilised ovum --a single cell , splits in to 2 cells then they in turn in tern 4 cells and so on  and so forth. In single baby this continues till enough cell mass is created and the then there is  differentiation  of cells . In the case of  identical twins the cells separate at very early stage, before any cellular  differentiation  has occurred. From this I feel that the soul does not enter at the time of the fertilisation . This also would be consistent with the finding that many fertilised , defective ovum get aborted at very early stage of the development without lady knowing that she was pregnant ( for may be 7days. ).
     The concept of reincarnation is the only one that can explain the apparent " injustice" that is seen in the world. The statement that we are all  'sinners ' does not answer when we see cases like Kelly Anthony or the children born with cerebral palsy, or when they get molested. What kind of sin did they do ? To 'blame ' it on Adam and Eve doing sin is not logical as I should not be held responsible for what my forefathers did. But if one takes in to account the past lives , not just one . but  many lives , then this can be easily explained . Every action has a reaction , so every action --karma -deed -has reaction , good or bad. We can not be ' free ' from this cycle of birth and death till this 'LAW OF KARMA ' is nullified . and the remainder is zero, May be that is why we see 'tough ' life all great saints at least in Indian culture. e.g. Tukaram , Meerabai, Dnyaneshwar or even The Jesus Christ . May that is why before his Resurrection he did not want anyone to touch his body . (till he burned out all his past deeds . )

Wednesday, March 28, 2012


   I have seen ( in news or on TV ) many different ways of the ' proposal  '  for the marriage . But the one that I am going to tell you is most 'unusual ' and ;unexpected ' .
    When I was consulted on this 78 tears old lady , I had not expected the problems that were to come in future. I saw her in the PCU , the Progressive Care Unit. She was admitted by her doctor , when she failed out patient treatment of the respiratory infection . I saw her and she did not look bad. She had some fever up to 101.5 and was minimally short of breath. Her oxygen saturation was OK. On examination she had some crackles on both sides on the back side. So I was shocked to see her x-ray. The x-ray showed extensive pneumonia. I was not all happy with the findings , as this was indication for the disaster  to occur in the future . I ordered several tests to find the cause of the pneumonia and ordered to transfer to Intensive Care Unit. I was worried that she would get worse and will need to be on respirator.
    And it did happen.  As I expected her condition  worsened.and she was intubated. I had to increase oxygen to 100%. I had started her on antibiotics,and continue to watch blood oxygen . I consulted an Infectious Disease specialist.After talking to him I did bronchoscopy and obtained samples for the cultures  In spite of the treatment ,  3 dayes went by and no improvement had occurred.I was talking to the family several times She had daughter in Chicago and her friend who had the power of medical decision .He was quite aware of the critical condition I was not sure if she was going to survive. In spite of all the work up we had no answer as to the cause of pneumonia and in spite of all the treatment and antibiotics,  she  was not any better.
    I discussed the condition with the friend and with the ID consultant and decided to start her on large dose of steroids , I had told the POA , the friend that if this does not work up  did not have any other idea. That afternoon when I went to Intensive Care Unit I saw all the nurses in the patient's room . I thought that something must have gone wrong So I went to the room and I saw the the friend kneeling down , holding the patient's hand , The nurse had stopped the sedation , so the patient was awake. THE FRIEND WAS PROPOSING  THE  PATIENT. AND SHE HAD ACCEPTED IT !!!!
     I was not sure as to what to make out of it. But to make long story short, the steroid worked and she improved in next 3 dayes and was taken off the respirator. She did go home in a week.( I Still believe it was the steroids and not the marriage proposal).

Saturday, March 24, 2012


   As mentioned there is circle of the mind . In this circle the action leads to impression , which in turn leads to desire , which in turn leads to action , which again leaves with oppression's. Now if one repeats same action then the impression that it leaves will be deeper and longer lasting , more difficult to remove etc.It does not matter weather this is good or bad. e.g indulging in sex or drugs or devotion to God or learning music. The energy for this 'storage ' of the impressions is derived from 'causal body ' and actual 'storage ' occurs in 'astral ' body.
     Now all beings have these bodies. But there is difference in development of the mind , intellect and ego. As mentioned in past there are 5 coverings in our body . The physical body is made of 'food ' . so called "Annamaya Kosha. " The astral body has no physical element , so has no food sheath or 'Annamaya Kosha ". But it has other coverings, mind (called Manomaya  Kosha ), the intellect ( called Dyanamay Kosha ) and the one more is life , (Pranamaya Kosha ). In the universe 'everything ' has these coverings. But the evolution of each is at different levels. We divide the things in the universe in to 4 different classes. 1 stone , 2plant , 3animal , and 4 human beings. In the stone level none of the things  are  evolved. In the plant kingdom the food sheath, and the pran or life sheath are evolved . In the animal kingdom the food , the life , and mind , are quite fully evolved and to some extent intellect sheath is evolved at varying degree. In human beings all 4 are evolved, the food the pran the mind and the intellect. I have left out only last and the best, which "Bliss " or " Anandmaya ".sheath . This one is is in the causal body and we as human beings can 'open ' or evolve with  the efforts  or meditation.I mentioned ego earlier as ego is nothing but false understanding that we are 'physical body ' , when in reality we are the inner core or the energy stick or the reflection of the God . The 'sin ' that Adam and Eve committed is that they got attached to sense organ pleasure and forgot their origin and the purpose of the different sense organs. They tasted the 'apple ' in the center of the 'garden of Eden ' . The 'garden is our physical body , the apple is sense organ pleasure (may be the sex ) and that is why after eating the 'apple ' they were 'ashamed of their body ' and started 'covering ' the body .

Friday, March 23, 2012


    This is one of the stories that I am sure can happen to every doctor. We doctors like to do the 'practice ' of the medicine  , by 'the book ' .  Now a days we are told to do things based on the evidence. i.e. evidence based medicine as it is called. But if we follow the 'book ' every time , we don't need doctors , we could do it with the  use of the computer, which is fed the information about the patient, and it will decide the further testing. Then we will be doing all the tests for 55 years old or  90 years, based on 'complaints' or the 'findings ' on the examination or on early testing. ( Abnormal chest x-ray in 90 years old patient with dementia , may not be worked up , even if there is high chance of cancer, but with computer based medicine , which may not take in to account the age and the mental ability we will be doing all the tests, which will not 'help ' anybody. The story that  I am about to tell is one that will explain this thinking.
    37 years old patient was referred to a gastroenterologist. He had some diarrhea and had sigmoidoscopy, looking inside rectum and lower part of the colon . He was found to have a polyp . So he was referred to gastroenterologist. When the gastroenterologist asked him about the polyp , he was quite mad . "You guys are concerned, about fxxxxx polyp, and no one is doing anything about the fever that I am having for last 2 months . " He was having fever and had diarrhea and had lost 30 lbs of the weight . On further questing it was realised that he was homosexual . So the possibility of HIV was high and other possibilities like 'lymphoma ' was also considered. He was admitted to the hospital . Upon the work up the diagnosis of HIV and also of Hodgkin's lymphoma was confirmed . The Hodgkin would need treatment with chemo therapy, which would suppress immunity, which was all ready suppress by HIV. Also with the chemotherapy one could become 'impotent' .  Due to such risk we usually tell patient about the risks , and advice them about precautions . In this case it was very different. He was HIV positive and was homosexual. So when I saw a note written by the oncologist which stated that " the patient was informed about the risks and was told to preserve sperms in case he wants to . " I was surprised.  If one takes in to account the special situation in this case , this was nothing more than writing from the 'book ' The special circumstances were not taken in to account. THIS IS WHAT I CALL GOING BY THE BOOK.!!!  

Tuesday, March 20, 2012


    Sometimes we are in a situation, that we as doctor don't know  how to handle it. If we tell the truth, we look like 'heartless ' doctors who do not care. . If we avoid telling the poor prognosis, we continue to do tests after tests that are of no use to the care of patient. So we continue the futile care and add to not only the cost but to the heightened unrealistic expectations . At this stage it becomes difficult to talk to the family , and explain the futile care especially if you have not seen the patient before and so don't have rapport with them. Some doctors handle it very well and others don't. All of us develop our own style.  Those of us see patients in ICU, we face these situation quite frequently.
     I was called to someone who was transferred from another hospital . His  cardiologist had called me about this patient . He was 75 years old patient who was diagnosed to have congestive heart failure. But in last 3 months he had gotten worse , with increasing shortness of the breath, and more cough . Increase in 'water pills' to treat this had not helped. This got so bad that he was admitted, and then patient was put on respirator, and I got call and he was transferred to bigger hospital, and I was called in .
     I saw patient, and spoke to the family . (This story is 25 years old, when cardiology tests that are now  easily available were not there. )The cardiologist, who was also their primary doctor had send all the records and in fact I had lot of information, which is usually not there when patients are transferred. When I looked at his x-ray I realised that we may not be dealing with congestive heart failure ,but patient may have 'pulmonary fibrosis ' , scar tissues , which can mimic heart failure. I am not saying that patient did not have heart problem , but the worsening was due to worsening fibrosis. Thia means that HE MAY NOT IMPROVE . I realised that I have to buy some time to see if my thinking was correct. So I continued to watch him and I as I expected he did not improve. I continued to talk to the family, and slowly told them about the fact (as I saw ) that main problem was not heart failure , but the scar tissue and it is not likely to improve. This did not go very well . They were very agree, that the diagnosis was missed and he was not treated and now he was dying.
      His condition continue to get worse, and the need for oxygen continue to get worse. Time had come to talk to them about the fact that he may die , in spite of all the treatment and may we need to consider stopping all the aggressive treatments and make him ' comfortable '. This was a bombshell , they all stared shouting and were very angry , not only at the situation but also at the cardiologist who had missed the fibrosis, which was 'obvious ' to me . The things were going out of hands . I had to SOMETHING. I decide to do some thing unusual . I asked them to answer a question .I said , "Let me ask a question. When your father dies  where do you think he will go  ? "  ' What do you mean  ?'   " exactly what I asked , where do you think he will go , after death ? " I got the expected answer , 'off course with the Christ in the haven. ' I looked at them each one in the eye and slowly said , " Is it that bad that you are all shouting and fighting and blaming everybody  ?"
     There  was a pin drop silent. I had no problem making him 'comfort care ' and he died . The family had no problem accepting it .

Monday, March 19, 2012


    As noted before there are 3 bodies and each has different functions. Even though we think that it is physical body, which does all the functions, like thinking , memory , learning, the real thing behind the scene is the astral body . I will give an example. I call it"  circle of the Mind  ". Someone offers me a pizza,  and pressure that I have not tasted pizza ever . So when I see pizza , I would have no special feeling. i.e. either desire to eat or dislike about it. But now I decide to taste it . (this is the action that I did ).Now I either like it or hate it. So the action that I did , created an impression , either positive or negative. Let us assume that I liked it . So this impression is stored in the brain , and when I am hungry next time , I think of eating pizza , and I end up getting it and eating it , which in turn creates an impression and this again leads to an action .This is circle of the mind. Action -impression- leading to action--leading to again an impression.
     Now these impressions are stored in the physical brain , but they are stored in the astral brain  in 'absract ' form . ' This may be the reason why one notices that we see 2 children of the same parents, having very different 'likings'., even at very early age. We also see child with extreme talent either in music some other field, and we can not explain this based on the education that the child got . When we die, the physical body is gone . So the stored up memories , education etc is gone . But since  all this is stored up in abstract form in the astral body, when we are reborn we have different physical body , but SAME ASTRAL BODY , which has same impressions . So we come back with our memories .(As they are in the absrtct form we are not going to remember people, or places etc , but the memorries about learned music or religion will remain ).
    The astral body does provide with energy , that is required for the every action. The causal body is the seat of Consciousness. and without it we will not be 'there '.Let me give little different example. If someone asks a child, where does the light comes from in a room , the answer will be the light bulb. But then one realises that if we turn off the switch then even if the light bulb is good . Also if the electric wires are not good then, also the bulb will not give light. So if one thinks that switch is the source of light . But if one turns off the main , then also we will not have the light . But again that is not the real , as the elecricity comes from power company . BUT IS IT REALLY THE SOURCE ? Similar thing exist in our body . You may say that everything is in the physical body, then I will ask a question. If you touch something , the recepter in the skin will trasmit it to spinal column, via nerves and from spinal column , it goes to the brain , where the chemical impulse is changed to emotions. But if you hold your wife's hand , or hold your child's hand or your mother's hand or your patient's hand , the feeling will be very different. SO IF THE CHEMICAL REACTION AND THE RECEPTORS , THE NERVES, THE SPINA CORD AND THE AREA OF THE BRAIN ARE SAME WHY ARE THE FEELINS DIFFERENT?

Sunday, March 18, 2012


    Sometimes one can not stop saying  that it is not my problem or that is not my specialty. Today what I see most of the times is  doctors saying that 'this is not cardiac issue or not surgical or not ----put any speciality issue. Then someone has to to take charge and find out as to what may be the problem.
    This happened in case of Ed.
     Ed was my patient for sometimes. His problem related to my field was very minimal . He was quite obese, weighed about 280 lbs, and had BMI ( body mass index ) of 39. Just for the information , BMI of 25 or less is considered normal. and more than 35 would be considered morbidly obese. He had 'sleep apnea '. He had sleep study and this was confirmed , ad he was advised to use pressurised mask called cpap.
unfortunately he could not tolerate it . So I had no choice to consider use of oxygen with sleep . This is  not recommended by American association of sleep society. But sometimes if the oxygen drop is very low or occurs for prolonged time I tend to use it . So from ' my standpoint ' there was no major problem . I was seeing him every 5 to 6 months.
    He was admitted to the hospital for low blood count , and I was consulted as he was short of breath . He did have some obstructive disease and was on some inhalers, but increase in shortness of the breath was due to drop in hemoglobin , which carries oxygen , and when it is lower amount of oxygen carried is less and then patient feels short of breath.  So I saw him . There was not much for me to do as such , as he was also seen by the cardiologist, who had declared.( through his nurse practcener ) that there was nothing  'wrong ' with his heart, and no specific treatment change was needed from his stand point. He was also seen by hematology, a blood specialist, who was following him for long time , as he had drop in his blood counts in the past and needed  'iron ' shots. There was no specific 'cause ' of his low blood count was found by them and he was told this was due to " chronic  disease " .(To my knowledge he had no 'chronic disease ' that could cause the anemia. )
      So after I saw the patient I could not sit without doing any work up to find out why Ed had anemia. So I ordered iron level , and it did come back low . So I called the hematologist and asked him if I could get Gastrointestinal doctor to see him and do ' bone marrow ' aspiration . (Bone marrow is the source of the all the blood cells-- one can call it blood cell factory, so if one wants to know the cause of low blood counts we can go to the source of them and see if the factory is not producing enough or the problem is some where else ). The bone marrow was showing low iron . So now the question was where was he loosing the iron/ blood .
     When I spoke to the GI specialist to rule out loss of the blood through gastrointestinal tract, his answer " we did check his colon and stomach 10 months ago and everything was OK. " I was not very happy with the answer , so I  convinced him look at the patient and redo endoscopy to check out stomach . He did do it , it was OK and he 'signed off the case ' as " From GI stand point patient was clear ". So I decide to do examination of the small intestine . ( stomach and colon were clear, so only logical thing left was to check the small intestine .) I also called the GI MD and asked him to do , what is called the capsule endoscopy , . in which patient swallows a ' capsule ' and it send pictures to a camera worn by the patient around the belly .  The small bowel  x-ray did show some abnormality in the 1st part of the small intestine and when he had the capsule test it SHOWED A SMALL TUMOUR IN THAT AREA .
     I was very happy that I had followed this closely . But my happiness did not last much long, as when he came to office for the follow up , he was not very happy . He was referred to a surgeon to take out the tumour, who told him that " he was too high risk for the surgery " and he should go to Mayo Clinic . He could not go to Mayo as it was not on his 'Insurence Plan '.So after all the effort we were back to square one .
     I had to do some thing. He had called the GI MD , with no success. I knew someone who did minimally invasive surgery as well as other special endoscopic procedure . I am very glad to let it know that this was successful and he removed the small intestinal tumour through endoscope.

Saturday, March 17, 2012


    It is amazing to know that the enlightened  Rishis have given us the structure of Astral body , which is suppose to be replica of the physical body , so well that it fits in to our understanding of the anatomy of the human body. These thing were described in scripture written  many thousands  of years ago.
     The astral body has a spine , just like the physical body . It has 3 coverings just like the physical body. The human spine is covered by 3 layers, the outermost is Dura matter, the middle one is the Arachnoid and the innermost is Pia matter.The human body has the brain-cerebrum then the spine with it's cervical dorsal , lumbar , sacral  and coccygeal parts and then the nerves. similarly the astral spine has these parts called Chakras, and their extension called the nadies. ( According to Scriptures there are 72000 nadies. ) The Astral body is the source of power to the 5 'dnynedriyes' (organs of the perception ) and 5  Karmendriyes  (organs of the action ) and stores the 'impressions ' in 'abstract ' forms  which are called "Saunskar " . It provides energy or powers by 5 Pranas which in human body manifest as crystallisation circulation , assimilation ,metabolism and elimination, As mentioned the astral body is made of 24 principals .The Astral spine is called 'Sushumna' and it extends from coccygeal center( Muladhar chakra ) to the brain . This is the one which is the source of the energy . Within the Sushumna are 2 other astral spines called "Vajra " and the " Chitra " The Vajra extends from sacral area or the   Swadhishthan  chakras upward to the brain . The Vajra allows the astral spine to 'move ' or 'expand ' or ' contract '. On the other hand the  Chitra is the source of "consciousness " or the spiritual activities . In the human body there is   ' sympathetic '  and 'parasympethetic ' activities . These are responsible for the things which are not under our will . e.g heart rate the blood pressure or the activities of the intestines etc . These sympathetic chains run  on the sides of the spine . In the Astral body this is represented by 2 chains called 'Ida ' and the 'Pingala '.
    The causal bod is the 'thought ' behind the whole human body and is called "Brahmanadi " 


  I am not sure what constitutes an emergency. I had read it somewhere . that. "inadequate planning on your part does not constitute emergency on our part . " So in my office sometimes when   my office staff tells me about someone , who  'has to be seen , because of the emergency,'   'I want  to know  what exactly is the problem.
   It was Monday. The Mondays are very busy. So when I entered thee room and saw John , I was surprised, as I had seen him less than 10 days ago . He was my new patient. 65 years old male with history of smoking one pack  of cigarette a day, now with shortness of breath, and cough. My impression was COPD -chronic obstructive pulmonary disease, damage to the lungs that accrues with smoking. We advice him to stop smoking, offered him various options, to help cope with symptoms that would occur with quiting smoking and arranged to do breathing test. This is to  check on amount of lung damage that occurred with smoking. This was done next day and we called him to let him know the results. He had lost almost 40 %.We started him on medicines and again told him to quite smoking. He was set for the follow in 6 weeks.
    So I was not sure as to why he was seeing me so soon. I took chart and went out of my room . It was 3-45pm , and I was seeing the patient scheduled at 3 pm , so I was not very happy . I asked my office secretory as to why he was here. She had simple answer, " he said it was emergency. "I went back in the room  and asked him why he was back so soon . I said , " As I understand it is emergency, ". He said  , ' Doc, I can't smoke . ' I was not sure what he meant by I can't smoke , and how that was an emergency. His answer was not much clearer. He said , ' since I saw you , I had tried to cut down on smoking, . But now when I tried to smoke I can't smoke . ' " what do you mean you can't  'smoke' , I asked .He answered , ' I can not inhale . When I tried to inhale it does not go in my lungs . '
     I was still not sure what does this mean, but I decided to check him out . I listened to his lungs , they had some wheezes . I asked him to open his mouth and looked inside , and I saw the answer to his question and the problem .
   He had a perforation in the hard palate , so when he would  try  to smoke the smoke would leak through the hole and not much could get in the lungs, hence his statement , his feeling that he could not smoke.
    I referred him to ENT, throat specialist, had biopsy and the diagnosis of cancer.
   I still can't understand how not being in position to smoke is an emergency.

Monday, March 12, 2012


This one is one of my stories, that occurred many years ago. The year was probably 1988 or 1989 . I was in the office . I was about to leave the office, when I got a call .There was a new consult for the 'vent management ' , . Which means someone had difficulty breathing and needed to be put on artificial support to help breathing , with respirator and I was asked to help manage the respiratory failure.
      When I called ICU and talked to the nurse I came to know that this was a young patient, 35 years of age, and had cardiac arrest, and had heart attack, and he was luccky  to be in the hospital delivering flowers. So he was in "right " place and so got quick help, got put on respirator, was seen by cardiologist, got help.Now I was called in . I was some what surprised to know that this was only 35 years old patient with the heart attack.
      I used to live very near my office , so I decided to call home , so  I could go home and have some time spent with the kids and then go back to the hospital . I went home , had a cup of tea, and decided to go back . As I had thought my older son wanted to come with me , he was about 6or 7 years old and quite well behaved. So I agreed.
      When I reached Intensive Care Unit, I told my son to sit at the desk and I went to see the patient. Usually with these type of patients or cases not much needs to be adjusted. When I entered the patient's room , his nurse was there and his girlfriend was also there. I talked to the nurse, examined the patient, and talked to his girlfriend. The examination was unremarkable. His pupils were big and did not respond to the light, a bad prognostic sign, though it could be due to number of medicines that he got with resuscitation. He was not breathing on her own , was unresponsive,though blood pressure pulse were OK.
       When I talked to the nurse and saw the chart I realised that this guy came to the hospital to deliver the flowers to some patient and as he was leaving the hospital , he had heart attack right in the lobby. His DRUG SCREEN was positive for COCAINE. Now it was easy to make diagnosis, 2 and 2 always make 4. He must have taken cocaine and then had cardiac arrest. I was about to start dictating the note , when the nurse told me something. She said , 'I don't know why , but he is oozing from any site that we take blood from . His coags, ( tests for the checking of clotting of the blood ) are OK. 'I could not figure it out either . So I decided to talk to the girlfriend again . I asked her if he was on any medicines, any drugs that she might have forgotten to tell us.Her answer was shocking and eye opening. She said , " now that you are asking me I remember that he used to take lot of aspirin whenever he did cocaine, you know that he knew that cocaine can cause heart attack and you know that aspirin prevents it !!!! "

Sunday, March 11, 2012


    This is a very old story . But I still remember it as if it occurred yesterday. I was called in for anew consult. As I got the information from my office, I noticed that it was a26 years old patient with diagnosis of the pneumonia, My office takes some information , like name , age , diagnosis, referring physician's name, what is the room no. and how quickly I have to see patient. We also get insurance information. so that if I am not on the insurance plan , we ask some other doctor who is on the plan to see. This also avoids lack of the follow up that may occur due to we being not on the insurance , then asking patient to see other doctor and transfer records etc. So when I looked at the paper  from the office I noticed that this 26 years old patient had Medicare , Normally Medicare is only after age 65 years or some one who is disabled for the long time. . So I was sure that this patient was disabled.
    When I entered the patent's room , I was shocked . I have seen many miseries, seen gruesome things but what I saw , may be because I was not prepared for it , was shocking. The patient had Hydrocephalus . , Very Very big head. with very  small body . His head was more than double the normal size, but the upper and lower extremities were very small. The whole thing was very unusual to say the least, and horrifying at worst.
      I reviewed the chart, looked at the x-ray and looked at the old records . Patient was from one of the nursing homes where the most or all the patients are mentally challenged . Many of them develop aspiration, food going wrong way, instead of going in the stomach , it goes in the lungs. So they develop pneumonia. This patient was not any different. I decided to call the mother who was the guardian. I wanted to know about several things , some history, if she would like to consider 'feeding tube  ' in the stomach called  PEG. to prevent aspiration , and in the future Tracheostomy to handle secretions, I also wanted to know if she wanted to to consider DNR , especially since there was no Quality of life, and the condition was not likely to improve.
   The mother was in Chicago. I called her  . Someone else answered the phone. The mother came on the phone . I said , 'Hi This is  Doctor  xxxx . I am  a lung specialist and I am taking care of your son  xxxx. .I just wanted to talk to you about his care and ask some questions . '
     What she said was shocking or may be I did not expect it .  She  said " Oh doc , for last several years I have been praying  God  that this chapter would " end " in my life , but,    - --. Tell me what can I do for you . "


    There is more to the story of the creation , than what has been mentioned. One thing is that the interaction between 3 Gunas or the qualities and the 4 Mahabhutas or the Elements , 'Organs of perception ' and the organs of action ' and the body are formed , but not in the form that we see it . The Nature or the "Prakruti" has to act on it to have a final product of the body that we see. By the way in the human body  Rajasic quality interacting with space element results in 'Speech ' , the element 'Air' or Wayu  results in the development of the H and or the grasping ability , the element of 'Teja ' or the energy creates legs or locomotive ability. ability for the procreation and the excretion comes from the elements of the water and the earth respectively.
    So the Astral body is formed by 24 principles , namely 5 organs of action  , 5 organs of the perception,  5 Big Elements ( Prachamahabhuts ) , 5 Pranas ( energy ), the Mind (Manas ), the intellect ( budhhi ), the ego ( Ahankar ).and the feeling ( Chitta ). (In Revelation 8-8, there is mention of 24 'elders' which may be the same elements of the Astral body that we were talking . )
    The entire visible universe is or can be divided in to 4 different categories.This has nothing to do with biology, i.e. birds, aquatic , mammals etc. But it is based on the concept of development of , or evolution of different " KOSHAS ".The 'stone' , the 'plant ' , the 'animal ' and the most evolved 'human beings '. There are 5 Koshas or the coverings . , namely the "Food " (Annamaya ) , the "Intellect " ( Dnyanmaya), the  "Mind " (Manomaya ), the "Life "( Pranamaya ) and lastly the " Bliss" ( Anandamaya ) Each of these coverings are developed in the above mentioned 4 different categories in the physical universe. In the human beings all 5 are evolved , while in the " Stone "level, none is evolved. In the plant kingdom , the 'food ' and 'life ' are evolved. In animal stage the ' food ' , the 'life ' , the ' mind ' are evolved , ( may some intellect too . )The bliss covering is evolved or can be evolved only in the human beings.

Saturday, March 10, 2012


     As mentioned there are 3 bodies, Causal , Astral, and the Physical. These 3 bodies are related to 3 worlds or the 3 Universes , namely the causal astral and the physical. The Physical universe is what we see. So corresponding to the physical universe is the physical body . So as the entire universe was formed with 5 Mahabhutas, (5 Big Elements) , 3 Gunas ( 3 qualities ) and their interactions. These are represented at various parts in the human body. Please note that the 5  elements that form the Universe are changed when they represent in the human body.
     When the Satwic Guna acts with 5 Mahabhutas;5 big elements they form 5 organs of perception. The interaction between Satwic with the " space  " --element makes the Ear in the human body. The interaction of the element "wayu " and Satwic Guna creates human skin . The interaction between Satwic guna and "Teja " creates human Eyes. The interaction between Satwic Guna and " Water " element creates the Taste and lastly the interaction between Satwic guna and the element " Earth " creates quality or the ability to smell.  Note that each subsequent element has the qualities of the presiding one . So one can 'Hear ' the 'space ' ,  'Hear ' and 'Feel ' the wind or the 'wayu ' , 'Hear ' , 'Feel ' and 'See' the 'Fire ' , 'Hear ' , Feel ' , 'See ' and ' Taste ' the water and lastly with the 'Earth' one can have all 5 qualities, i.e. hear, feel see smell and taste the 'Earth.'
      Now similar thing happens with the Rajasic and Tamasic Gunas when they act on 5 big elements. Because the Rajasic quality makes on to 'Act ' , the interaction between Raajasic gunas and big elements creates 5 organs of action . These are  'Speech ' , 'Grasping ' with hands, " Locomotion " with the legs , 'Procreation ' and 'Excretion '.
    With the interaction between Tamasic quality and 5 big elements creates 5 different parts of the human physical body , i.e. flesh, blood , air, energy and space.
     Please note that there is more to creation than just these things . There is Ego , Chitta, (feeling ), Mind , Intellect and some people add 5 " Pranas"---5 forces of so called energy.

Friday, March 9, 2012


    It was 8pm . I was quite busy that day . The Mondays are usually this way . Patients that have some issues on Friday or over the weekend tend to call on The Monday. So there are more calls , more messages and more patients to be seen . Sometimes when a patient needs a procedure , it gets postponed to Monday , so the Mondays get very busy. So it was Monday, 8pm . I was out of my house  since 7 am . I thought I was done for the day , when I found out   a note -message in my pocket . I looked at it and realised that it was a new consult  that was called in earlier that   afternoon, and I had forgotten about it. I could have seen it in the morning, but next day was quite busy, and this one came in at 2 pm . I always like to clear all work same day and do consults that are called in by 6pm . So even though it was 8 pm I decided to see the patient.
    I took the chart and went to the room . I had known his diagnosis  by  looking at the chart and  had seen the x-ray. As I entered the room I saw 84 years old male . He looked quite comfortable. He was on 2l oxygen , saturation was 96 %, good . He was not in any distress. I thought to myself, this should not take long time.
     I have my own style of asking questions,  may be to 'fit' my style of dictation. So I started asking questions, " do you have high blood pressure, diabetes, TB , heart attack, stroke etc" May be I was in too much hurry or tired , I was asking questions too quickly, he could not answer them . Then it happened . He said , rather slowly, " D O C T OR, I A M  84, -OLD , Y O U  A R E  Y O U N G  , A L L O W   M E  S O M E  T I M E  T O   A N S W E R ."
    I was ashamed of myself, as I take pride in how I talk to patients and explain them medical things. I quietly pulled a chair and said , " I am sorry, tell me what is going on ."

Tuesday, March 6, 2012


   These are some of the statements made by the patients or their  relatives that have taught me or left me with deep impressions. Some of them are funny , some of them are serious and some of them are just statements to remember.
    1. I saw this 80 year old male for the first time . He had chronic cough. When  I asked him , how long he has the cough, he said , " Now let me see, I had in 2000 , may be even before that. I think it got worst after I got divorced. " I was not sure if it was his way of remembering the time or he was just saying things just for the sake of it.  Since he was 80 , and got 'divorsed' I was little surprised. So I asked him , how long he was married , thinking that it may have been second marriage and may lasted for the short time . His answer was surprising. He was married for almost 45 or 47 years . I was more surprised , so I asked him , " What do you mean , it took you 45 years to know that 'this' one is not for you?". His answer was shocking or funny or eye opening. He said , " you know how it is , I knew it at the time of the honeymoon, that she was not 'right ' one for me. " . " So why did you wait so long ? " I asked . "Well it is like a stock, you know it is not good stock and you should sell, but  you think it may go up one day and so you continue to hold it .Same thing happened to our marriage."
    2.I saw this young lady age27 years. She was from out of town ,and had flown to this area for the visit . She started with some chest pain and came to hospital . i was consulted to rule out blood clot in the lung . She had no previous history of any medical problem or any lung issues. She was on 'birth control 'pills . As you know these can increase incidence of the pulmonary embolism ---clots in the lung . Air travel or long distance car ride can cause phlebitis-and the they can travel to lungs. After listening to her story and examining her lung I wanted to check  for the phlebitis in the legs . So I asked her if I could check her legs . She made very serious face and said , "Oh no, you should have told me earlier .," I was not too sure as to what she meant by this . So I asked, 'what do you mean ? ' She said " If I would have known , then  I would have shaved them ."
   3. She was 18 years old and came to me shortness of the breath and the cough . She came with her mother . Her chest X-ray showed diffuse infiltrates. ---congestion. Not sure I decided to do bronchoscopy and biopsy . On asking other history, I came to know that her mother owned a pet shop. She had sold it and then got home some birds as the were not the part of the inventory  of the store  that she had sold. I thought of something . Could it be an allergic reaction to the bird dropping. I ordered the blood test to confirm it or to rule it out. I did her bronchoscopy and  all the things came back OK . Instead of doing "open lung biopsy ", which would have meant major surgery, I decided to start her on steroids and told them to get rid of all the birds at once. After extensive discussion about the steroid , their side effects , precautions etc, I gave the prescription  and they left.
   At the end of the day as I was clearing the messages I saw the message 'The mother had some more questions '. When I called her her question surprised. (This was 1981)She wanted to know if she could continue giving her daughter the "birth control pills !"

Saturday, March 3, 2012


    As stated before the cycle of beginning of the universe and the end of the universe , also called PRALAY goes on for ever , i.e. there is no 'begining' or the ';end' to these cycles . So at the end of one cycle every thing gets dissolved in to "ONE" or the unity and at the beginning of the cycle slowly different things start to come out . So in the beginning of the cycle , the space is created , then air then energy then water and then the earth or the solids. The all 5 'Mahabhutas' are dissolved in , at the end of the cycle and now they" come out ". Same is with the 3 " Gunas". i.e.Satwic, Tamasic and Rajasic. If one thins or the ingredients need to build a house he will need bricks, lumbar cement , paint etc, same way if one thinks of 'building ' a new universe , then  one will need certain ingredients . But even before this process is started one can think of the other requirements that will be need . To conceive this one needs intellect, then resources and power to preserve. ( Just in case of the house  constuction , one will need IDEA as to to how house should look, or the knowledge as to how to construct, then resources to build it , and then power to preserve it , not being destroyed by Bad elements. )This is exactly the concept in Hinduism.
      The "Rajasic" quality is needed to create new things, "Tamasic " to dissolve it, and  " Satwic " to maintain the universe. Now according to the laws of physics, nothing can be destroyed, only changed .e.g . water if heated it changes to water vapour.or if burn coal it gives heat and ashes are left. so the coal is converted to 'energy' and ashes. So nothing gets destroyed. So in the universe things get changed to different plains , from physical plain or universe to astral universe.But never gets destroyed. Here comes the another concept , we have 3 universes, physical , the astral and the causal . As the mentioned above we need   "CAUSE" , then , the " CONCEPT" and then the actual product. This will be similar to the 3 universes that are mentioned . But then we also have to think of ' micrcosum' and ' macrocosum' . So now we have 6 different universes. Now there  are different 'incharge' gods of these universes. Just to mention the names , Ishvara, ( m acrocosmic causal) , Hiranyagarbha, (macro cosmic astral.)Virata (macro cosmic astral. ) . Pradnya, (microcosmic causal ), Taijas ( microcosmic astral ) and Visva( microcosmic physical ). (In Revelation 8-2, it is mentioned that the God has 7 angels, so these 6 deities and the Mother nature or Mahaprakrity are the 7 angels.) We will see next how the interaction of these thing make the universe that we know and should  know.

Friday, March 2, 2012


      The year was 1982-83. I had started my practice for the couple of years. So in away I was ' new '  doctor i.e. not smart or experienced. I was consulted on one of the patient, I still remember the room no. , It was ICU bed 4. She was 37 years old female who came to hospital with pain in the belly. She was worked up and found to have acute gall bladder attack , i.e acute cholycystitis. The surgeon took her to surgery . The surgery went well. Like any other operation it was done under general anesthesia and so patient was on respirator. Usually this is removed once the surgery is over and sedatives wears off. This time though she was awake she could not be weaned off or taken off the respirator. So she was transferred to ICU. The surgeon felt that it was effect of the anesthesia and once it wears off then she could be off the respirator. Somehow she was still on respirator after 24hrs of the surgery. So then I was consulted.
      I was glad to get the consult, ass being new I needed new patients. As I said this was 37 years old female , who had no previous pulmonary history, i.e. no history of asthma, smoking, or even shortness of breath. So I thought that it will be very easy to wean off the respirator.But as I tried to get her off the respirator I was successful only up to certain point , then she would not tolerate reduction in the support from the respirator. I was not sure why I was having problem with the weaning in this young lady with no previous pulmonary problem or any medical history.
      I re reviewed the x-ray and noticed that diaphragms were somewhat elevated. It gave me an idea , could it be that lady had paralysed diaphragms or some muscle weakness.. I could not send her to x-ray department to check on the diaphragmatic movements . So I ordered NIF, the test to check on respiratory muscle strength by asking patient to suck in and measuring the pressure generated. She could hardly generate any pressure. So my hunch that she may have some muscular weakness was most likely correct. I called   for a  Neurology consult to give opinion and may consider some testing , like EMG to rule out or confirm neuropathy or myopathy.
    The neurologist came in and saw patient and told me that , It's your problem , not a neurological issue. . I was disappointed. He did not bother to order any test to confirm or rule out my diagnosis. I was willing to accept that I was wrong , but not not just by some one's opinion . It would be acceptable if the tests were done and I was proved wrong. I could not order the test myself as they have to be done by neurologist and the order must come from neurologist.
     I was determined to find out or may be I did not know any other explanation for the difficulty in the weaning. I called the surgeon , who had done the gall bladder surgery and requested him to do muscle biopsy . He was quite reluctant as she had not " fully recovered" from first surgery . I was quite firm and requested him to do it 'anyway'. He agreed .
     The biopsy was done .It took long time to get final report , but preliminary report was " MYOPATHY" So my diagnosis was correct . The final diagnosis was  Mitochondrial Myopathy , I was never able to get her off the respirator. She is still on respirator at home , still comes to me and does not want to go to any other doctor  even for non pulmonary problems. The surgeon had called me for many other consults and the neurologist has retired.