AND THE PATIENT SAID CONTINUED

    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 . "

HUMAN BODY AND THE UNIVERSE

    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.

ORIGIN OF THE UNIVERSE AND CREATION OF THE HUMAN BODY

     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.

AND THE PATIENT SAID --CONTINUED

    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 ."

AND THE PATIENT SAID------

   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 !"

ORIGIN OF THE UNIVERSE -CONT. 2

    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.

UNUSUAL PATIENT-8

      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.