Sunday, August 23, 2015


   In our life we 'know' the fact and we have certain beliefs . But we have difficult time separating them . In one of the old Indian story there was a King who had a very smart assistant or adviser. For those who are Indians , I am talking about the AKABAR and the BIRABAL . So one day when they were walking in the city , the king saw a mother kissing her child , which happened to be a ugly looking child. So he made a  comment that how can she not know that child is ugly? Birabal said that she 'believes ' that her child is the most beautiful child . The king did not agree. So next day Birabal called the mother in the palace and asked her to bring the most beautiful child from the city  to the palace by that evening. The mother left the palace and then looked all over the city but could not find a child that she thought was better looking than her own child . Finally she took her own child to the palace . Birabal looked at the King and gave the mother gifts. So we tend to have difficulty when we want to separate the facts and our beliefs. It was said that president Clinton could 'compatmentalise' the different parts of his life . But really can anyone do that ? I do not like to talk about politics in my blogs , but I am amazed at the current state of politics . On one side people can't find any problems in their candidates or side irrespective of the issues that have come out including e-mails or IRS audits or our ambassador being killed ,or reporter's emails being tapped and so on . On the other side people who are supporting a candidate, can't find fault with statements like 'how good is Canadian health care system' or 'there is problem with corruption and lobbyist in DC , but I use it when it is to my advantage ' or many other . And to my surprise the people who believe in purity of thought believe in these candidates. (If a candidate states that there is increase in prostitution in our city , and I would like to get rid of it , but I have used their services when I needed it ,Do you think you would vote for him ?)I am also amazed at the attitude of one side when Lion was hunted and killed .One side which cares for the life of Lion but do not care for the life of unborn baby . And the other side which cares for the life of baby but have no problem with cruelty of killing the Lion or for that matter billions of animals that are slaughtered (approximately 10 billions  a year) to give us the 'food' . Those who are oppose to killing animals for fur,or for medical experiments , have not much problem with the way animals are killed daily .(For those who are interested there is a book The Ethics Of What  We Eat by Peter Singer and Jim Mason - this is' must' read).But that brings me to the medical story .
     I saw this young man , may be in mid fifties. He had quit smoking few years ago and was having increasing cough . He was treated by his doctor with antibiotics and then when he did not get better he had a chest X-ray . The X-ray showed congestion and small fluid and so he was treated with more antibiotics and then a repeat X-ray was done . It did not show improvement , but showed worsening . So he had a CT scan and then was sent to me . When I saw him he was quite Short of breath on physical activity , but oxygen saturation was good. I saw his CT scan and knew that most likely he had a cancer of the lung and the fluid was due to the cancer and that would make it inoperable. I could have done drainage of the fluid as an out patient and then the Bronchoscopy and the called the catheter insertion for the malignant fluid and then asked cancer specialist to see him . Doing it as an out patient would have taken may 3 weeks or so to get treatment started. I did not want to wait . So I admitted the patient , did drain the fluid next morning , had a surgeon see him do additional biopsy and put in a catheter to drain fluid periodically on 4th day of my first visit. (For recurring fluid collection we can put in catheter, that can stay in for several months and patient can drain own fluid as needed). We got him to see a cancer specialist 5th day and then the treatment was started . I was very proud of myself to have done this so quickly. I spent significant time answering all the questions . He was discharged . He walked in our office about 4 days or so after discharge, complaining that the catheter was clogged . I was not in the office and even if I was in the office , I could have done nothing . I spoke to him on telephone and told him to go to ER . I called the ER physician and told them the problem and the solution , namely to use certain drugs to unclog it . The ER physician did not do it , but decided to admit him . I went to see him at 5pm and the catheter was still clogged . He was seen by another lung specialist who ordered CT scan but did not do anything to catheter. I went in and unclogged the catheter. The next day he was OK . On third day I was told by the admitting physician that he wanted to change the lung specialist . he was not 'happy' with me as I could not help him in the office .
      I was little upset at first as I had done more than anybody else . I diagnosed and got him started him on the treatment as quickly as nobody would have done it or did it . I was the one who unclogged the catheter , though not in my office at 11 am , but at 5 pm . So why was he unhappy? The answer is in what I said in the title of the blog . He was MAD as he knew the outcome of inoperable cancer, that was aggressive . But he could not be mad at his smoking or the bad luck or the 11 years and 15 years old children . So HE could not SEPARATE the FACTS from his belief. This may be the same for the popularity of one candidate over others.We are all mad about the state that we are in . But we have difficulty to separate the facts from the fiction.Many of the things that we would like to change , are not practical or even possible. The TY anchors and the multimillion dollars contract talk show hosts have difficult time with this , He was only a unlucky patient!I 

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