Friday, May 25, 2018


        I enjoy medicine -otherwise with today's demand on medical practitioner for non medical things and things that do not help patients , I would have stopped doing medicine..I also watch news and the political commentaries. In my life time I have never seen such a divide.It almost reminds me of OJ court trial. The conclusion drawn are diagonally opposite. I wonder if they were watching same proceeding or not . But I often get the same feeling when I see patient. This is not new .In past it has happened to me that I was asked to 'clear' a patient for surgery and I thought that the patient was terminal. He was thought to have incarcerated hernia and needed surgery . He was seen by hospital MD , surgeon and cardiologist and kidney specialist . When I saw the patient , his hernia was reducible and nor incarcerated , his heart was pumping at 10 % and he had kidney failure and he had water in lungs .Not only he DID NOT need surgery , he could not have SURVIVED THE surgery. So when I told this to the daughter , she was surprised as OTHER doctors had cleared him . I went see her again and showed her the labs and the heart reports and the chest X- ray .We made him DNR and he dies in 24 hours . This brings me to today/s story . 
       When I was passing in the hallway of the hospital , I came across an Indian male , who mistook me for some one else . His wife was admitted and so I hello to them . I came to know minimal things about her medical problems . I told them that I will let the physician -that they knew , and from behind mistook me for him -know that she is admitted. After about 3 days or so I got a call from hospital . The nurse told my secretary that I was to see a new consult . My office took the information . I was busy with office patient and then I got 2 text message to call the nurse . So I called . The same lady that I had seen socially 3 days ago , was the new patine. She was short of breath and they wanted me to see her . She was so bad that the nurse called me on my cell phone twice. I had no call from any other doctor -not even the Hospitalist MD. The nurse had called Rapid response team twice. I spoke to the nurse and got brief history and gave orders . I told her to do chest X- ray and a blood test to check on congestive heart failure and give couple of medicines and call me is she was not better in 1 hour . I also told her that I will see her at 5 pm , which was 2 hours from the call.

    I went see her at 5 pm I looked at the chart to see as to what was happening . I saw the chest X- ray. and I saw the blood reports and then went to see the patient. There were family members and the nurse . She was little better . I told them that I felt that in my opinion she had episode of congestive heart failure and with new medicines she should improve in next 4-6 hours . I ordered medicines for the congestive heart failure and also for wheezing that she had . I did not get any call from the nurse after that . I went to see her next day and she was like new person . I readjusted her medicines . I reviewed the chart . She was seen by cardiologist , Infection specialist , blood doctor and hospital doctor . I did not see any mention of the things that happened yesterday in any of the notes other than hospital MD and the infection specialist , who had called me personally after he saw the patient .
If one would look at the cardiologist note only ,he would not know that she went in congestive heart failure.  There was no mention of the problem that she had , that was related to HEART .So 2 people seeing same patient , have very different view of the patient . 

Saturday, May 5, 2018


      I came across a book that had discussion on KARMA .I liked some of the discussion that was done and some I did not agree . But overall it is a good book. I have talked about the Karma and the principles governing the Law of Karma. in the past . But I will summarize them before I talk about some new points. There is no patient story in this blog.
        The Karma is ACTION. To understand this one must realize that sometimes the INACTION can be ACTION. Sometimes the Action may not be obvious as it is MENTAL or not DIRECT. .So let me explain . If i am walking see someone in an accident and I walk away without helping . That not doing anything -inaction - is ACTION . This is simple to understand. Now the Mantle Action. I am think harm or lustful for someone once , because we had fight , it is not an Action .But if I continue with the same thought everyday it will become Action . (according to the book's author this is not action ). And lastly Indirect action is also Action . The claim that I do not kill chicken or pig and so I am not doing the Action of Killing is not right thinking . It is an Action .
        The action or the Karma that we do is called KRIYAMAN Karma .Some of it will have effect in this life and rest is stored as SANCHIT KARMA or 'Stored Actions'. So with several lives , we collect or store millions of Karma and not all can come to fruition or have effect in present life . So the Karma that are to come to fruition in this life -that happened in past lives -, is called PRARBDHA. This determines the 'outline' of our present life . In Hindu religion 4 actions or PURUSHARTH are described ,namely ARTHA-MONEY ,KAMA-DESIRES ,DHARMA-RELIGION AND MOKSHA-ETERNITY OR NIRVANA . The first 2 namely ARTH or money that we can make and KAMA or desires that we get fulfilled in this life are to some extent predetermined  and the to follow DHARMA or do our duties and try to achieve MOKSHA or eternity is in our hands . But we continue work for Money and Fulfillment of our desires.
           This does not mean that we can not WE can not CHANGE any outcome in our present life, But it is like swimming against the current and so our efforts must not only Match the force of the past Karma -PRARABDHA , but outperform it. If we do not try in this life ,thinking that our future is predetermined , we are CREATING new Karmas that will determine our next or future lives . So we must try and that may change some of the weak effects or the reaction to our previous life's  ACTION .So this effects of past life Karma determines our LUCK to major extent and some is determined by our present life Actions. 

            So the verse in BHAGAWAT GEETA , which is often coated from Chapter 2 , verse 47-or misquoted . The verse states that one has Right to Action but not to the fruits-EFFECT- of the ACTIONS. The usual interpretation is that just because one tries does not mean he will get success . This is true , but the other meaning or the one which I like is that whenever there is Action or Karma , there is going to the fruit or reaction or effect of it . One can not say that I will not accept this or that fruit or effect . SO EVERY ACTION HAS REACTION -ONE CAN NEVER BE WITHOUT ACTION AS ONE CAN NOT STOP THINKING EVEN IF HE CAN STOP PHYSICAL ACTION.