THE FATHER,THE SON AND THE HOLY GHOST OR AUM TAT AND SAT

  I received a message from one of the reader of my blog, that liked one of my old blog entry on Mysticism in MAHABHARATA. So I was thinking about the mysticism not only in Hinduism , but also in Christianity.On the surface  many things that are written or said, appear to be open for interpretation or misinterpretation. The story of Adam and Eve.The question that I have is how valid is the statement that we are all sinner as we are born to Adam and Eve . This off course comes from the people who DO NOT believe in reincarnation.So Where do I come from and what sin did I commit that I am paying for it ? I do have explanation . But I will write about it latter. But today I thought about writing about the THE FATHER , THE SON AND THE HOLY GHOST in CHRISTIANITY and the same thing in HINDUISM . You can tell me how wrong or correct I am after reading this blog.
    In Christianity they always talk about the Trinity . It is also said that The Jesus Christ was the SON and he will save us. But no one talks much about the origin of the universe. So the FATHER is the SAT, The SON is the TAT and the Holy Ghost is the AUM. The SAT means the Truth, the Unchangeable, the ever lasting. When one refers to something as REAL , it does not mean that in our conventional way . The computer that I am using is real to us and is not imagination . But it changes every second , even though we can not recognize it at that time.(We can see it very easily if we check it in a year or two. )So the SAT means one that does not change and from this SAT everything originated.  Thia is why it is the FATHER . The SON is the thing that comes out of the FATHER. But to start the universe we need to have ENERGY and the Matter. So the UNIVERSAL CONSCIOUSNESS or the SON which pervades everything in this universe is the TAT--THAT.The first word or the creative vibration. This is AUM or the HOLY GHOST. The matter is inert and has on spirit or energy and that comes from the SON or TAT The union between the SPRITE and the Matter leads to the beginning of the universe. The AUM is mentioned in the Bible as the 'In the beginning was the word and word was with the GOD 'So in Hinduism we talk about the first sound is AUM . The AMEN of Romans , Greeks, Egyptians, Jews and Christians the AMIN of Muslims , all are same as AUM .
    So The SUPREM GOD does not move and does not change and is the ulimate reality and is the origin of the universe is the FATHER OR THE SAT. The SON is the all pevading consciuosness or the Sprit or the energy or the TAT without which inert mattaer can not DO anything ,is the TAT. And lastly the HOLY GHOST is the AUM or the first sound or the matter or the mother nature.    

BAD LUCK

      I was reading a book which was suggested to me by several people . The name of the book is WHEN THE BREATH BECOMES AIR .' This was written by Paul Kalanithi . When I went to library to check it , I realized that it was quite popular book . There were 50 plus people ahead of me . This is a story of a neurosurgeon who was diagnosed with metastatic lung cancer at age 36 and died of it. The book it written by him and published by his wife after he died . Couple of points that I want to make is that 1 it is quite depressing book especially towards the end , and I did expect it . Even though I see this every day I was not very happy with the end even though I knew the end . Secondly I felt that too many physicians FEEL that working HARD and neglecting family is OK. I am not surgeon ,but I have heard that in all the surgical branches there is hard work and rude behavior and it is carried from residency and then in practise . (I want to make it very clear that Dr Kalanithi was not rude )But why is it OK to work 16 hrs?(In my residency time I did do 34 hrs straight too ).This may be the cause of stress and suicide. But the reason I started this blog was to tell you about my patient.
       So I was consulted on this 35 years old female who was having some shortness of the breath and question of pneumonia . When I talked to the patient and her family , I realized that I was dealing with a sad story.She never smoked and did not drink alcohol and about 20 months ago she was diagnosed to have a stomach cancer . By the time it was diagnosed , it was inoperable. So she was given chemotherapy and she did OK , She was in 'remission '. But then as many times happens , she had recurrence . She was given radiation and chemo and continued to struggle The cancer had gone to bones and brain and lungs. She was short of breath and needed oxygen . Due to the spread of the cancer to boned , she was needing blood transfusion every other day . I reviewed her chest X-ray and the Ct SCAN AND FELT THAT THE CANCER WAS NOT ONLY IN LUNGS , BUT WAS BLOCKING THE LYMPH DRAINAGE . This was making lungs 'stiff' .The lungs  which are normally like dry sponge , are now filled with water -or in this case due to cancer and these stiff lungs needed much more energy to open or expand them and that resulted in shortness of the breath . This fluid in lungs also caused the oxygen transfer to be poor and needing oxygen .So there was not much I could do . Just like in case of Dr Kalanithi , sometimes we can not offer anything but prayers .
      Even though I believe in reincarnation and the Law of Karma , I am not sure how I can explain this or accept it I still call it BAD LUCK !!!

EXPRESSIVE APHASIA

   I have always wondered about the speech or the language.  when different people speak English they speak in different way or have different accent. I think that the accent is based on the person's mother tongue.. (Is it called mother tongue as the father does not get a chance to speak?)So when a Hispanic speaks English it is different that when I Frenchman speaks. I for that matter can distinguish different accents of people from India . This is how the CHINAYA SUZUKI thought about the music. He felt that the music was a language and as we don't have to teach a child a language or it's peculiar accent , we don't have to teach a child a music if he or she can hear it frequently. But I am not talking about this part of the language , or the speech . I am talking about the origin of speech .
    The other day I saw this patient with respiratory failure . She had been a smoker and had rheumatoid arthritis . She came to hospital with shortness of the breath and then needed significant oxygen .When I saw her in ER , she was mildly short of breath and was talking OK. She may have had pneumonia , but when I saw her old X-ray , I knew that she had fibrosis , or scar tissue in lungs , probably from her rheumatoid arthritis. So I knew that we are going to have some tough time in weaning her oxygen . But she did OK , did get little better. But then the hospital doctor called me one morning telling me that she was confused and he did not have idea as to the reason for it . So when I saw her and examined her I was surprised . She was NOT CONFUSED ,but had Expressive Aphasia. SHE COULD NOT EXPRESS . She could move her all extremities. But when I showed her a pen , she could not name it and was saying yes to every question. So I knew that she most likely had stroke . I ordered a CT scan of the brain and asked a neurologist to look at her . CT scan of the brain showed abnormal area in the frontal lobe . The neurologist had no specific diagnosis.
     The speech is formed as a result of coordination of various areas in the brain. Broka's area and the Wernikoff's area are the 2 known area and the frontal lobe stroke most likely caused the aphasia .When we see something, we know what it is and the word is formed . When we listen to a sound we know what it means and when we touch , we know what we feel .
  For those who are interested in Hindu Religion , there are 4 different speeches , They are called PARA. PASHYNTI MADHYAMA AND VIKHARI. The last one is spoken speech . May some day I will try to explain what the other 3 mean .

EMR ANAD HEALTH CARE

    When the EMR , or electronic Medical records were introduced , it was thought that we will have better care. In fact the federal government paid physicians to participate in it . So many physicians got it. Those like myself who did not participate in it got reduced payments for the services than those who did get EMR . So now that we have it is the quality improved? In my estimate it has not only not improved , but has gotten worst. In the hospitals we HAVE to do EMR and I spend at least one and half hour extra doing it . On top of that I often see more things in the records than actually has been done .
    I get notes from other physicians . Many of them are 6 pages . When I go through them I find that 4 new lines , every thing else is same as was in previous last 5 notes . This is due to EMR. The notes are Generated by the computer and the physicians pit in minimal new information and rest is carried from old note which was generated on first visit. In one of the notes one physician who started labeling problems with alphabets rather than numerical numbers, at the end of the note he ran out of the alphabets and had to label AA,BB etc. Were there more than 26 problems that this physician addressed in 15 minutes visit? But the reason I am writing this today is due to one of the patients that I saw .
     I was consulted on this 48 years old patient for the diagnosis pf pneumonia . He had no fever , no t much cough , but the cheat X-ray showed some congestion. So he was started on antibiotics and I was asked to see him.He also had low blood count and so a blood doctor was also consulted. He had also history of heart disease and so a cardiologist was also asked to see him . I saw the patient . He had history of a disease called sarcoidosis and when I asked him as to how it was diagnosed , he told me that he had 'OPEN LUNG BIOPSY' . When I examined him . he had big belly. On examination he had enlarged liver and spleen and had fluid in belly. I had ordered CT scan of the chest and the Ultrasound of the belly. The CT scan showed that he did NOT have pneumonia and the mild congestion that was seen on plain chest x-ray was related to previous lung biopsy . The ultrasound of the abdomen DID show that he had cirrhosis of the liver and enlarged spleen and fluid .
    I did some further investigations. I called gastroenterologist and told the patient and his wife that he will need to see a liver specialist for consideration of liver transplant .
    I went back and looked at the EMR entries of one hospital doctor 3 different blood doctors and one cardiologist . EVERYONE had put belly examination as NORMAL on several different times . Some of these entries were done AFTER we had the US report showing enlarged liver and spleen . This the ' EMR and CUT and PASTE notes .   

KNOWN KILLER

    In medicine as in any other field we all are product of advertisement. Every one today is concerned about cholesterol , even a 80 years old patient who has end stage lung disease and controlling the cholesterol would make no difference in his shortness of breathing for sure and probably in his survival. But he continues to be given statins and he also spends lot of money for the medicines that I am not sure is going to help. I would like to have someone do a study on these kind of patients who have significant co morbidity or are very old , to see if lowering cholesterol is beneficial or not. But then there is no benefit in doing this study for the pharmaceutical companies. But then there are known killers and we pay no attentions. This is primarily due to media bias. The two most common disease get attention in media are heart disease and breast cancer . But then there is no excitement in Influenza. That is what I am talking today .
    The flu is common and most of the people do not  need or seek treatment and get better. But then physician like me see the sick ones and some get so sick that they are in intensive care unit and even die.
    It was 6-30 pm and I was about finished with my patients and I had couple of notes to be finished . So I was happy . Then I got a call from one of the hospital doctors, asking me if I could see a new patient who was 'sick'. It was a27 years old Hispanic patient who had her first delivery and was found to have low oxygen and so this hospital doctor was asked to see her . In tern he asked me to see her . They had thought about some unusual conditions like amniotic fluid embolism. In this condition at the time of delivery the fluid from the sack enters the mother's blood and gets in lung and causes all sorts of problem . The bad part is that there is no real treatment. So I went to see her . When I saw her she not complaining of shortness of breath or any chest pain. Her respiratory rate was high and her oxygen saturation was low . Her lungs were congested and her chest X-ray was bad . It showed pneumonia . In this young lady who had just delivered a baby , I thought of vomiting and aspiration . But then there was no history of vomiting .She was in ER day before with symptoms of cold or flu and had 'rapid flu test' . It was negative and so she was sent home . Her history was suggestive of flu . So I started her on treatment and called infection specialist. I also transferred her to ICU . I was worried about the pneumonia and flu causing respiratory failure. I was right and she did get worse . There was no embolism. She was in ICU for 4 or 5 days . needed high flow oxygen. But she slowly got better and after in the hospital for 10 days she was sent home.
   So flu almost killed this lady. But with shear luck she got better . Recently I have had 2 more otherwise healthy patients in ICU and needed to be in the hospital foe 12-14 days. I also heard of 35 years old male loosing life due to flu.  

STATIASTICS

    Many years ago I had heard comments about statistics. I am sure you can add to the list . Some of them are interesting. One was ,' there are lies and then there are lies , and then there is statistics!'. The other one was, 'if you put one hand in boiling hot water and other in ice cold water, then statistically you are at comfort'. So sometimes when we in medicine talk about chance , or probability or possibility , we truly are talking about what happens to majority . But by no means this is 100% but we in medicine  get our opinion further confirmed as majority of the patients behave as we knew from the statistical data. I  have been always puzzled as to why in a study all the patients don't behave same way . The sugar is sweet and everyone who tastes it will say the same thing . Then why a particular cancer in particular stage behaves differently in different patient ?These thoughts came to my mind when I saw this 74yeras old patient recently.
      He is a 75 years old male whom I saw several years ago . He was maybe 60 years old at that time and had come to me for an abnormal cheat x-ray. So I did a CT scan and then a biopsy. The CT scan showed that he had a mass in the right lower lobe and there were number of lymph nodes in the chest that were enlarged. This indicated spread of cancer to these nodes and made him inoperable . The biopsy confirmed the lung cancer . So he was treated with radiation and chemotherapy. Per my 'thinking' -which was based on the statistical data of this type of cancer in inoperable stage,- was that  he was not going to last mare than 2 or 3 years. I had told him that and he had known it to from other sources including oncologist. Certainly we all read the same books and know the same data. But he did not die . So I continued to follow him and he did OK .Few years passed by and it was more than 10 years that he not only did not die , but had no evidence of the cancer. Then it happened. His CT scan was abnormal. So I did a bronchoscopy. He had new cancer . So he was started on new chemotherapy. We could not do more radiation . So I followed him up and he continued to do well . May be it was 2 more years and he coughed up blood. So I did a bronchoscopy . His chemo was stopped as he had no evidence of cancer . My bronchoscopy showed that he had recurrence of the right sided cancer and there was a different cancer on left upper lobe . The interesting part was that in spite of me seeing the cancer - a new one - on left side , the CT scan did not show any cancer, not did PET scan showed the cancer. ( another statistical data which was not right ). So he was given different chemo . This time he got quite sick. He could not eat and developed weakness in the legs and had number of other issues . He also had pneumonia and swelling of the legs . He was so weak that he could not even stand up . So I told him and to his wife that there was no sense in continuing the chemo and made him 'no code' . He was discharged to extended care facility. He needed help and the wife could not have taken care of him at home . I did not think he was going to last more than few weeks . So I forgot about him . He showed up in my office about 7 or 8 months down the road . He was walking , and eating well and was doing OK.So I did another CT scan and as it was abnormal did another bronchoscopy. He had recurrence of the cancer on left , but none on right. I had stopped counting as to how many times he was cured or told that he was cured and had new cancer or recurrence of the cancer . Statisticaly this is impossible . He has defied  all the odds. 

ONE STEP AHEAD (OR BEHIND)?

      When one goes to a physician , they expect that the physician will be one step ahead of the treatment or the diagnosis. And most of the time it works . But at times it is a frustrating and the story that I am going to tell is one such . As a physician we like to help , anticipate and treat or prevent the problem that may arise. So it is quite frustrating when we come across the surprise . So this is such a case that in spite of every one we did not anticipate the outcome .
      I saw this 45 years old male that had chronic cough . As usual I did the allergy testing and the breathing test . The allergy test did show some allergies and the breathing test showed that he had mild asthma. So I put him therapy for the asthma and he did improve . In next few months he was seen by me for one or two times and then was lost for follow up . He had some personal issues and so was out of town and was doing well and so postponed the follow up . He came back to me as he again had some cough . His lungs sounded clear , and so I sent him to an allergist. Then he had further allergy testing . When he went back to him he was told about the allergy shots . At that time he was having shortness of the breath . So he was given steroid shot . He continued to feel shot of breath , so he decided to go to ER. There was nothing positive in the ER on examination or chest X-ray . But I decided to do CT scan .The CT scan showed that he had clots in the lungs and he also had pneumonia . So the pneumonia was not seen on plain X-ray and he had no fever. He was admitted and was started on blood thinner . He was anemic and so I did the work up and I also did the work to find out as to why he would get clots. I also called a blood and a cancer specialist . We treated the pneumonia and then he was discharged. He was followed up by me and the oncologist . He was readmitted in less than 10 days as he had fever . in spite of the antibiotics . So he was treated for the pneumonia and was seen by infection specialist . I ordered the scan of sinuses as I was not convinced that the fever was due to pneumonia. He did have bad sinusitis , so I called the ENT consultants . They saw him and did not do anything different. They told him to see them in the office. He was doing better and was discharged. I saw him and he was still weak and was seen by all the consultants as out patients. I did follow up CT scan and it showed that the pneumonia was better . He was feeling better and had no fever and was back to job .
        So when I saw him in the office I was happy that finally he was doing better and we had done well with him , anticipating the clot in first place , then the sinus infection and then the follow up on Ct scan etc He looked OK and told me that he had much improved energy . The I saw him and noticed a lump in the neck . It was lymph node enlargement. He had shown it to his PCP and he told him to watch  it . I was not going to do that. I ordered an antibiotic and CT scan of neck . I told him to see ENT doctor  ASAP .The next thing that happened was that he was admitted and  had a biopsy of the enlarged lymph node and HE HAD LYMPHOMA.