as i work in ElderCare for 16 years now, thanks to GE Volunteers who made me medical officer for LSP-little sisters of the poor [ https://www.littlesistersofthepoorindia.org/bangalore-st-joseph ] hosur road, Bangalore in 2005, every interaction is humbling. one learns to see life with respect love compassion as nothing lasts forever. this too shall pass...
65+
life begins and ends in shoonya. we start as babies fully dependant on others to care for us as our body-mind are still continuing their development till about 5 years. 65+ man returns to where he started, as hindu dharma declares to be a child again. visited a much respected leader who lived as a king, made sure all who came in touch grew to their fullest potential, happiness smiles joy was his gifts to so many, my family including. i saw him now 86 years old, unrecognizable but for the sparkle in his eyes that lit a million lives hearth. sat with him, tried in vain to get a conversation going but all i got was a smile behind which there was sadness. long term memories are retained by brain, so when older topics came up, he lit up. now and the future are not his forte now...past is a time warp in which he is ensconced. his family tried in vain to care for the carer who gave many lives a reason to live and prosper. they cant fathom the deep emotions that must be running in his mind, when eating sleeping or just sitting is a huge task. love is all one asks, few are fortunate to get it..many dont and silently leave with nobody watching. money wealth fame gold food drink entertainment power sex...all that which roared in youth like a hurricane is now a distant memory. mind sails a much calmer sea...eating to live, sleeping to heal and sail, till the day comes to adieu.
healer by heart
when a bunch of kids came together in 1985 to study medicine, little did we realize that long after we started we would forever stay frozen in time here. One of us was the healer with charm compassion and smile on his lips, dr vd umashankar. We all went through the grind of an academic mbbs with minimal skills focus but macaulayean rote learning of mostly old redundant information that was irrelevant in 1985 itself, leave alone today. After acing final year exams it was time to play doctor and we ducklings waded into water guided by many well meaning seniors and teachers. USA UK Australia remain sinkholes for all top talent, a curse India endures to this day. After passing PLAB and IELTS dr umashankar was posted across NHS England to learn the ropes of Acute care medicine. His unique ability to feel his fellow human's pain, be it a patient friend family or total stranger kept him from chasing his other passions. Uma was a polyglot dabbling in Tamil poetry prose drama singing (iyal, isai, nadagam) apart from being an entrepreneur from early on. When we were preparing for pg entrance exams uma opened his first business to explore the market. His native insights kept him floating for a while but sharks ensured his fledgling venture folded. Nevertheless uma qualified as an anaesthetist and worked mostly in some of the largest teaching hospitals in south England. Southampton, Bristol, Merthyr Tydfil, Swansea, Swindon were his training grounds. Uma specialized in cardiac anaesthesia from Cleveland clinic, USA to work in cardiac sciences for two decades. When patriotism brought him back to Chennai in 1996, little did he realize deja vu waiting for him. I had the fortune to sit through many deep dives with him, where he refused to accept that business needs to be profitable to sustain. He built a hospital that was on par with the edifices he trained and worked in while at UK USA. When we attended his hospital inauguration, we could only marvel at his brilliance in bringing India to Bharat viz., best of healthcare to a small town. His patients included many of us, who in his noble eyes were all equal; just humans in pain, to be healed. Sincerety dedication sharp clinical skills and 100% devotion meant an army of fans, of which I am astonishingly one. Which UK qualified intensivist would sleep on attenders cot to bring back a patient from jaws of death, for uma it was just another day. The sharks that ended his earlier venture smelt blood and started circling him. Some of us privy to his work and thoughts saw these sharks and warned him. A mother defended her baby from a tiger with just a stick in Indian folklore. Uma saw his patients as his brood and fearlessly continued his healing mission. When he least expected it, a great white lunged at him taking him out of the water and ending a 54 year old story. Those of us watching from sidelines could do nothing but cry. Dr Umashankar, a legend, the likes of whom are like the kurinji flower, blooming rarely but leave a gash deep in our hearts. Adios my friend, we learnt from you how to have only the patients welfare in mind when confronted with myriad options. Acute care medicine is poorer today uma, your patients lost their saviour. Soldiers give their today for our tomorrow. Doctors sacrifice their youth in training, for their patients. Dr Umashankar gave his life, till the end remaining a true healer.
Dr Thanga Prabhu: Acute care medicine, Health Informatics, Digital Health expert. mbbs classmate of Dr VD Umashankar aka ums aka umasha :(
Jack n Jill
As I walked to Yercaud foothills a nomad passed me with his brood of ducklings, moving as one large amorphous amoeba. Just hatched, probably few days old nevertheless cuddly little fellas cute as all newborn are. I decided to get a pair and after a bout of haggling had Jack and Jill in my hand. It feels nice to hold life in one's hands. Being an ER doc I get to hold the dead many times and it aint easy. Many nights the thought of the cold hand haunts me endlessly, who once would have lived like the rest of us. I quit active practice as I couldn't handle the emotional turmoil of seeing people dead, if lucky in one piece. ER work is battlefield work, nothing easy about it. No matter how much one prepares for the shift, it is annoyingly novel every time. The feeling of a bird held in hand is how foetus moving in the belly of a pregnant mom is described in medical textbooks. Being the unlucky sex, we men can only plant seed but it is left to the female to nurture and grow a life. As I held these two fellas in my hand, it reminded me God exists.
At home a cozy home was identified for the ducklings. An unused bird cage which saw 30 pigeons breeding actively was soon home to our babies. As I walked in to my house Brownie our dachshund was curious to see the contents of the bag I held in my hand. I decided to introduce Jack and Jill to the master of the house Brownie. As I lowered the bag for brownie, he lunged at it as if I was offering a gift to him. I should have recognized the hunter turning on in him, alas it slipped my mind.
After settling into their new home with fresh water to drink and some rice to eat, Jack and Jill announced their arrival with a medley of kee kee kee. The baby sound ducklings make till they learn to quack kept us company for many days. My elderly parents who always bred hens, cocks, pigeons, ducks, turkeys were overwhelmed with joy to hold the lil fellas in their hand.
After an hour there was silence from Jack and Jill. I went to check on their wellbeing. Surprisingly both were missing from the pigeon hole that we had placed them in. Being babies, who are curious and inquisitive by nature they had decided to check out the rest of the coop. I closed the main door of the coop behind me and started looking for them amongst all the stuff that had crept into the coop, serving as a store now.
Brownie was furious that I had ignored him and not utilized his services to find Jack and Jill. His incessant barking with ears upright and tail pointed straight out was clear he was ready to serve his master, me. Or that was how I interpreted it then. He was actually hunting. In an earlier encounter Tiger his predecessor had sniffed out Nag, a 5 foot hooded Cobra in our garden and ensured my dad came nowhere near it with barking and display of his canine protecting his master. Eventually that snake was dealt with safely. Expecting a serpent I opened the coop door.
Hunter Brownie went straight for the jugular of one of the duckling, grabbed it and ran away. Before I realized what had transpired he had enjoyed the snack and came trotting for second helping. I disciplined him and tried in vain to explain to a hunter the morals of going vegan.
Dont know if it was Jack or Jill that survived this onslaught but after much searching found the survivor very quietly hiding in a nook. I gently extricated it and shifted to a safer place with strong mesh all around. Duckling was happy though it must have missed the brood that were its siblings and till recently his partner. Brownie was always sitting outside the cage like sphinx in rapt attention watching every move or noise it made. Life went on for the singleton with Brownie the bad boy eyeing it and desperately clawing away to reach it. One fine day there was silence in the cage. I found to my dismay my little baby on her back, probably dying of cold.
Jack and Jill came down the Yercaud hill,
Jack got eaten, Jill survived but in a few days joined him in the yonder.
Life goes on...
Patient Safety: JC, NABH, NABL
JCAHO has officially been renamed JC. Short and sweet to remember. All stakeholders from patients to healthcare providers can now benefit from the easy to use, simple guidelines. I like the Patient Safety area very much. [ https://www.jointcommission.org/resources/patient-safety-topics/patient-safety/ ]
Quality in healthcare delivery is not an option but essential. Even the healer can be a patient at times and that is when it hurts really hard. Medical equipment, technology, software are tightly regulated to assure 'Primum Non Nocere' - physician do no harm. Quality is a mindset beautifully exemplified by Toyota corporation with their TQM-total quality management philosophy. For a Japanese company to learn automobile technology from USA and Europe and replicate it in the Japan of 1945 that was emerging from the second world war with a clean reset was a moment. The Japanese penchant fro perfection be it in the art of tea making, ikibana (flower arrangement) or calligraphy flowed into industry. Quality was the single big factor which took Japan to world stage and compete with the likes of GM-General Motors, Mercedes Benz, BMW, Audi renowned car makers. TQM ensures quality assurance throughout starting from sourcing components from many OEM-original equipment manufacturers, to shop floor assembly, delivery and service. Medical equipment have top quality, does the system have even a fraction of that? Fact is no. If we get to bottom of the issue, it truly turns out to be gordian knot.
JC [https://www.jointcommission.org/], QCI-NABH [ https://www.nabh.co/ ], QCI-NABL [ https://nablwp.qci.org.in/ ] accreditation assures the end user of TQM in healthcare.
Life can be so ephemeral - Death and beyond
A few days ago I got a call from a person whom I hold in high esteem. His adult daughter had just passed away at 0230 hrs early morning. There was history of diarrhoea for three days after consuming hotel food, delivered by a food delivery company. Few questions kept popping up in my mind, after helping him face this unbearable loss and navigating a quagmire of unnecessary and repetitive processes. Corruption rears its ugly head to benefit from an emotionally labile condition that prevails. Looking at the workflow involved from the time death is suspected, multiple points of improvement were obvious to improve, all the way to support for grief.
1. Role of emergency services
2. Can food poisoning or Cholera kill in a short time (few days)
3. The Death identification, confirmation, certification process in India
4. MLC - medico legal case implications for death at home, autopsy procedures
5. Funeral arrangements
6. Grief/ Bereavement counselling
FHIR-fast healthcare inter-operability resource
FHIR came from Australia out of the frustration of complex HL7 ver 3.0 and RIM-reference information models. Fast Healthcare Interoperability Resource would allow a dunce like me to plugnplay. All complexity hidden from me, why do I want to know how many people built my car...all i want is my chevy. UI is also moving in this direction, so much so mommies play nursery rhymes on tablet/smart phone and jr soon knows where to dribble or soosoo to stop the annoying nursery rhymes. God it is bad enough being born to working parents, they expect jr to do all they dreamt but failed. IIT to start with....So when a baby can use tech, it should put people to shame saying hum pichle zamaney ke hain. Drs r famous for being technophobes but for anaesthetists whose danda runs on knobs and gases. FHIR is a God send but Graham the inventor probably is afraid of the big HL7 mothership and says it is still beta. We have HL7 India leaders in IAMI, guess they have had a chance to peek under the sheets. Pls share what u see or don't see, need to know both.
Hearing from folks on the field that the basic 'Z segment' tail continues to wag the HL7 dog in FHIR too. It is just a easier way to talk to systems using API calls and SOAP-XML but the basic HL7 design has to be revisited. RIM was an approach to get design out of the equation in creating a reference information model. Problem is it turned out to be a bigger monster that layety found difficult to grasp.
Only good thing that has happened is CDA-clinical document architecture. It is Case Record clinically high fidelity with XML running under-hood for system to system communication. CCD-continuity of care documents builds with CDA to create an EMR that can be strung together as a EHR.
Hearing from folks on the field that the basic 'Z segment' tail continues to wag the HL7 dog in FHIR too. It is just a easier way to talk to systems using API calls and SOAP-XML but the basic HL7 design has to be revisited. RIM was an approach to get design out of the equation in creating a reference information model. Problem is it turned out to be a bigger monster that layety found difficult to grasp.
Only good thing that has happened is CDA-clinical document architecture. It is Case Record clinically high fidelity with XML running under-hood for system to system communication. CCD-continuity of care documents builds with CDA to create an EMR that can be strung together as a EHR.
community citizenship
Hindu culture segments life into 4 phases; Baliya, Brahmachari, Grihasta and Sanyasi. Upto 12, 25, 50 years of age you progress to renounce physical world and live a life of detachment beyond 50 years of age. Notice the doubling and the fact that 50% of life should be for community/society. All great men have done this viz., Jesus, Buddha, Mahavir, Guru Nanak, Ramanujam, Shankara...Simple life with great thinking marks the few from ordinary mortals.
My dad has always lead by example, I am one of his chelas. Sharing your joy with others, that too those less fortunate who are neglected, alone, hungry and deserted multiplies it manifold. My decade with GE taught me the power of education, there can't be a nobler charity than teaching. He distributes food and clothes but I insisted on reading/writing material. While shopping in Vashi Hypercity was approached by college students volunteering to raise money for a cancer child patient. Gladly helped them. Crossword and Landmark setup shop offering learning pack for Rs 100 (colouring book, pencil, eraser) once paid for by a patron to distribute amongst Kamatipura children. Kamatipura is famous for prostitution, the book pack is for their children who came into this world as a byproduct of someone's pleasure. Life is difficult for these poor souls who earn a pittance for working 18+ hours 7 days a week with constant fear of sexual disease, violence and exploitation. I donated willingly to help these children who grow up hearing and seeing their mothers being abused daily. Went on a shopping spree for my young brood, picked up colouring books, crayons and a cap with India flag. Dad distributed rava laddu and samosa, I gave out books and crayons. My gift will last a long time and of the 30 many will become IAS, IPS officers, DRs, teachers who will remember the uncle who gave them these gifts. I want to bring digital education, oops before that English, Maths skills so they confidently walk tomorrow's stage.
With my dream growing we left, content 30 children will snugly tuck into bed with hope, knowing there are still a few left in this world who are happy in giving rather than taking.
My dad has always lead by example, I am one of his chelas. Sharing your joy with others, that too those less fortunate who are neglected, alone, hungry and deserted multiplies it manifold. My decade with GE taught me the power of education, there can't be a nobler charity than teaching. He distributes food and clothes but I insisted on reading/writing material. While shopping in Vashi Hypercity was approached by college students volunteering to raise money for a cancer child patient. Gladly helped them. Crossword and Landmark setup shop offering learning pack for Rs 100 (colouring book, pencil, eraser) once paid for by a patron to distribute amongst Kamatipura children. Kamatipura is famous for prostitution, the book pack is for their children who came into this world as a byproduct of someone's pleasure. Life is difficult for these poor souls who earn a pittance for working 18+ hours 7 days a week with constant fear of sexual disease, violence and exploitation. I donated willingly to help these children who grow up hearing and seeing their mothers being abused daily. Went on a shopping spree for my young brood, picked up colouring books, crayons and a cap with India flag. Dad distributed rava laddu and samosa, I gave out books and crayons. My gift will last a long time and of the 30 many will become IAS, IPS officers, DRs, teachers who will remember the uncle who gave them these gifts. I want to bring digital education, oops before that English, Maths skills so they confidently walk tomorrow's stage.
With my dream growing we left, content 30 children will snugly tuck into bed with hope, knowing there are still a few left in this world who are happy in giving rather than taking.
Tamil Nadu - Healthcare role model
My heart swells in pride to shout at the top of my voice that TN-Tamil Nadu (where I was born) has been declared a ROLE MODEL for Healthcare by WHO circa 2014. [http://www.deccanchronicle.com/140808/nation-current-affairs/article/tamil-nadu-healthcare-role-model-world-who] The reasons behind this success are uniquely Indian, which I dissect here. What happens in TN can/should happen in the ROW-rest of the world too. The load is heavy but with each of your shoulders we will lift healthcare, locally then globally!
Centrally purchasing drugs with a robust IT system in place gives purchasing power to drive down costs. Enforcing quality generic drug usage within the system weeds out corruption and unholy nexus between prescriber and manufacturer/supplier. Local empowerment and ownership makes the PoC-point of Care autonomous. Local manpower have sense of ownership, which anyway is high in rural settings. Urban living unfortunately forces strangers to live side by side. Participatory leadership with everyone clearly seeing the cathedral that is getting built means there is pride in the work done. Banavaram [ http://www.thehindu.com/todays-paper/tp-opinion/a-model-that-delivers/article4477096.ece ] and Nandivaram [ http://www.thehindu.com/news/cities/chennai/health-centre-near-chennai-achieves-over-100-rise-in-births/article5437244.ece] are examples of such work.
Tamil values system put in place in ancient times, effectively reinforced (by the likes of Tiruvalluvar) at frequent intervals has given the Tamil a unique rigmarole of living a disciplined life. Modern distractions do swing aam aadmi away to frivolous pursuits such as fast food, malls and never ending wants to keep the market based economy humming but the values are there, if one wants to uncover. I believe in the uniquely Indian-Hindu concept of life in 4 stages - balya, brahmachari, grihastha and sanyasa. If man lives a 100 years 12, 25, 50, 100 are the milestones for which one has to prepare in every stage. Notice how the periods double but the thing that caught my eye was that you should renounce worldly living by 50 and spend half of your life for Society. True wisdom emanates from one who has no want...Buddha, Mahavira, Jesus, Gandhi are all examples of this. This was practiced by all in ancient times, even by the Great Emperor Chandargupta Maurya, Emperor Ashoka's grandfather. He renounced his throne to come and live in Sravanabelagola (in Karnataka today) where a hill is named Chandragiri after him. How much discipline it must have taken for one to give up an Emperor's throne to live the life of a mendicant?
miracles still happen
I was witness to a miracle that unfolded in front of my eyes this morning. A tiny fighter (4 months old weighing just 4.5 kg) came in for VSD (hole in heart) repair. The way a dedicated team of clinicians went about performing an open heart procedure on this handful of a baby brought tears to my eyes. In earlier times he wouldn't have lasted beyond school, dying of heart failure/respiratory infections but now he will probably outlive me! Wah...yeah hui na baath?
Medical work is noble, spiritual, unique in that the skills mean difference between life and death...literally. To accomplish such feats a team of clinicians, technicians and healthcare miracle workers has to synchronize and work together with clockwork precision. Like a relay race the baton passes from one to another seamlessly, communication is subtle and in gestures mostly. A hand reaches out to have the correct instrument placed at the right angle with the right things included, which then goes on to become an extension of the surgeon's fingers to deftly weave his magic on the tiny heart.
When the sheets came off in the end for him to be transferred out of the OT, the tiny fighter caught my attention by his sheer smallness. As the team lifted him onto the transport incubator there were many tubes and lines, which I gladly extended a hand to lift.
BTW-by the way this too happened in a corporate hospital.
Medical work is noble, spiritual, unique in that the skills mean difference between life and death...literally. To accomplish such feats a team of clinicians, technicians and healthcare miracle workers has to synchronize and work together with clockwork precision. Like a relay race the baton passes from one to another seamlessly, communication is subtle and in gestures mostly. A hand reaches out to have the correct instrument placed at the right angle with the right things included, which then goes on to become an extension of the surgeon's fingers to deftly weave his magic on the tiny heart.
When the sheets came off in the end for him to be transferred out of the OT, the tiny fighter caught my attention by his sheer smallness. As the team lifted him onto the transport incubator there were many tubes and lines, which I gladly extended a hand to lift.
BTW-by the way this too happened in a corporate hospital.
head injury wonder
a RTA patient was admitted to one of the teaching hospitals GCS - 4/15 with SAH, LOC. In the corporate world this patient might end up with a huge bill (running into several lakhs), teaching hospital environment is different. Here the the team endeavours to practise medicine in an ethical way per hippocratic oath. Indiginisation runs in our veins as we grew up tinkering with ambassador car/lambretta scooters where repair is default, replace a luxury. Even the manufacturer is astonished to learn how much juice we can extract from a fruit :)
Patient went through HPE, FAST, airway secured, line access opened and neurosurgeon requested to assist. SAH was successfully evacuated. An intensivist team took over from here and gradually brought the patient back to GCS 15/15 to go home walking. Psychiatrist consultation was sought early to keep mental equilibrium as swings in mood during acute trauma are expected. Today he has been returned to the community by this wonderful team of medics, who work out of passion to serve. A refreshing change from a world, where even breast milk is sold and uterus hired like a bank vault!
Medicine is service...full stop.
God - east and west
the difference between eastern and western science is that in the west it is analytical as opposed to empirical in the east. We in the east accept things as they are and see realty as a spectrum. We dont look for cause/result always and can have all shades of gray from shoonya (zero) to ananth (infinity). God in my mind is a concept and you must see 'anbe sivam' a classic by Kamal Hasan to undderstand how everyone can be God. I am also drifting strongly towards Buddhist thought which preaches that the now and current is more important than past or future. I also am an admirer of Japanese culture of 'Perfection' in as subtle a thing as tea making or flower arangement (ikibana).
Stephen Hawking is a western scientist and he and his coworkers are splitting the atom to such an extent that now we are talking of a state in which matter can exist as matter or a wave. The further we go down that path, we are finding it is like going up further into space in search of other galaxies; both leading us to realms beyond human comprehension.
I believe our (eastern) approach to science and medicine is a workable way than trying to understand everything. What human intelligence cant comprehend is attributed to religion leading to the theory of religion begins where science ends.
Stephen Hawking is a western scientist and he and his coworkers are splitting the atom to such an extent that now we are talking of a state in which matter can exist as matter or a wave. The further we go down that path, we are finding it is like going up further into space in search of other galaxies; both leading us to realms beyond human comprehension.
I believe our (eastern) approach to science and medicine is a workable way than trying to understand everything. What human intelligence cant comprehend is attributed to religion leading to the theory of religion begins where science ends.
eye tracker
Met up with a friend working in Sweden for a company who make eye tracking software. The human eye is a dynamic camera that is pulled into action by six muscles each externally and one internally. Our gaze can reveal deep pyschological patterns. Desomnd Morris, a trained psychologist used gaze tracking to study the pattern in which one looks at a picture. Ad industry has used it to track the items of interest to customers and this information has been used to determine the hierarchy of product placement in supermarket shelves.
In criminology it can be adapted to be used as an advanced lie detector. When shown a picture of the crime scene, only one person will know the exact location of suspect items...the criminal. When I had my eyes tracked it was embarassing, as the picture shown was of a beauty in bikini. You dont want this kind of information to be shown with percentages on the areas seen most. Behavioural psychology can have many interesting experiments using this technology.
Medicos learn by observing. Our teachers used to always tell us to be like a sponge and absorb as much as you can. Interpreting images is a skill acquired by experience. No medical school curriculum can teach 100% all the possible images that one would be expected to interpret over a lifetime. They can and do teach the Process...the way to look at a medical image and decide, abnormal/normal first. Qualitative and then quantitative interpretation for the abnormality flows out as an impression. When we watch experienced clinicians look at a CT scan, xray, ecg, foetal monitor ctg or eeg and read it like the bible effortlessly, that makes us turn green with envy. When asked to teach a fresher on how that interpretation is done many a times the same clinician fails miserably :( We can walk but not necessarily know all the possible mechanisms which run in the background. The fact that only a few can be good Teachers, holds very true as to teach one must first know. The comes the difficult task of translating that into words that will explain it to another person. Work, Research and Teaching are a holy triumvirate and few have scaled this peak! Eye tracker can be a useful adjunt to analysze medical image interpretaion by a Consultant.
The technology is so small and sleek that Mercedes, BMW, Audi provide it as a nice addon to their higher range of cars. It sits snugly on the rear view mirror and monitors the drivers eyes. The moment he dozes, it warns visually and audibly to alert the driver.
What an idea sirji?
In criminology it can be adapted to be used as an advanced lie detector. When shown a picture of the crime scene, only one person will know the exact location of suspect items...the criminal. When I had my eyes tracked it was embarassing, as the picture shown was of a beauty in bikini. You dont want this kind of information to be shown with percentages on the areas seen most. Behavioural psychology can have many interesting experiments using this technology.
Medicos learn by observing. Our teachers used to always tell us to be like a sponge and absorb as much as you can. Interpreting images is a skill acquired by experience. No medical school curriculum can teach 100% all the possible images that one would be expected to interpret over a lifetime. They can and do teach the Process...the way to look at a medical image and decide, abnormal/normal first. Qualitative and then quantitative interpretation for the abnormality flows out as an impression. When we watch experienced clinicians look at a CT scan, xray, ecg, foetal monitor ctg or eeg and read it like the bible effortlessly, that makes us turn green with envy. When asked to teach a fresher on how that interpretation is done many a times the same clinician fails miserably :( We can walk but not necessarily know all the possible mechanisms which run in the background. The fact that only a few can be good Teachers, holds very true as to teach one must first know. The comes the difficult task of translating that into words that will explain it to another person. Work, Research and Teaching are a holy triumvirate and few have scaled this peak! Eye tracker can be a useful adjunt to analysze medical image interpretaion by a Consultant.
The technology is so small and sleek that Mercedes, BMW, Audi provide it as a nice addon to their higher range of cars. It sits snugly on the rear view mirror and monitors the drivers eyes. The moment he dozes, it warns visually and audibly to alert the driver.
What an idea sirji?
ElderCare & Mentoring
I went back to the old age home [ https://www.littlesistersofthepoorindia.org/bangalore-st-joseph ] where I run a charity clinic after a break of 18 months. how much one can do as a doctor if money is not part of the equation was/and is always evident there. every time I visit this home, I learn something new! saw a new patient whose daughter is a VP with a MNC...no not all residents are abandoned :) after seeing a few a patients, doing one ecg and accepting a simple soup (again simple but delcious) left with pride in my heart. oh, yaah I donated my 6 year old PC to the home to be used as EMR holder in the Medical Centre. Joy of Giving week mission accomplished.
mentored a yound medic, who is where I was 19 years ago. Freshly minted coin with big dreams in the eyes and youth on ones side to move mountains but the world can be a harsh place to freshers. It is like being born again after 10 months of comfort in our mother's womb, thrust out into the cold, loud, strange world. Add to it the aura of being called a Dr and the expectations from all quarters to be successful and famous. It is tough...my prescription: do what you will enjoy doing everyday of your life, dont do things to satisfy anyone but you. Heard an inspiring speech from a Medic who decided to go and live amongst mountain people in Ooty and gets satisfaction in being the change in their lives.
Was and will always be a big fan of Mother Teresa, who saw Jesus in all the filth and dirt of Calcutta...that is true worship and no wonder she is a saint.
upload to brain?
The MMI field is new and old. Since the time we threw our first stone weapon to hunt for food 10k years ago we have started interacting. The difference in 2004 is machines are capable of intelligence. As compared to human brain (millions of years old) computers are still in the single cell stage. As the human brain has evolved it has nicely adapted itself to the changing environs. Brain senses five main inputs - light(vision), sound(hearing), chemical molecules in gas form (smell), taste (chemical molecules in liquid form) and touch (basic sensor input).
Light is perceived as presence/absence, tone, brighness and colour (frequency).
Data-information-knowledge that is how processing occurs.
If the data is exploding in size will the brain evolve to process this or just selectively filter the info and use it? We sense the world by vision (light), hearing (sound), smell (chemicals as gas), taste (chemicals as liquid) and touch (attributes of objects such as temperature, dimensions in 3D, size, etc.).
Predominantly vision is used to input data. Modern machines are using sight, hearing and some smell to present data.
Is the sensory end organs' data processing necessary for it to travel to the brain? Cochlear implants prove that it is not so. Can we improve the efficiency of data acquisition? Does the brain work better when cooled (as PCs do)? How does the brain learn? What is memory? Can we write and read from memory directly into the brain? Is magnetism a way to reach the brain non invasively and interact with it?
Is it possible to directly read/write to the human brain? Vision is the primary means of inputting data now. In ancient times hearing was the main means of data acquisition (in India). What is memory? What is the real world like when not interpretted through a human brain? Is the perception affecting our basic laws of science? Einsteins theory of relativity says time is relative to the observer. Is sense also relative to the observer?
Light is perceived as presence/absence, tone, brighness and colour (frequency).
Data-information-knowledge that is how processing occurs.
If the data is exploding in size will the brain evolve to process this or just selectively filter the info and use it? We sense the world by vision (light), hearing (sound), smell (chemicals as gas), taste (chemicals as liquid) and touch (attributes of objects such as temperature, dimensions in 3D, size, etc.).
Predominantly vision is used to input data. Modern machines are using sight, hearing and some smell to present data.
Is the sensory end organs' data processing necessary for it to travel to the brain? Cochlear implants prove that it is not so. Can we improve the efficiency of data acquisition? Does the brain work better when cooled (as PCs do)? How does the brain learn? What is memory? Can we write and read from memory directly into the brain? Is magnetism a way to reach the brain non invasively and interact with it?
Is it possible to directly read/write to the human brain? Vision is the primary means of inputting data now. In ancient times hearing was the main means of data acquisition (in India). What is memory? What is the real world like when not interpretted through a human brain? Is the perception affecting our basic laws of science? Einsteins theory of relativity says time is relative to the observer. Is sense also relative to the observer?
brain
Epilepsy
Is it just the way nervous tissue reacts to death and degeneration? When the brain is deprived of glucose/oxygen it makes the animal go into tonic then clonic siezures. Is epilepsy a prinzmetal angina of the brain?
Memory
Reinforced neural circuitry which can involve vision, hearing, smell, taste and touch. When a path is used more than once the neurons and glia adjust themselves and next time when the impulse arrives it flows easily through the learnt path. So repetition is a good way of imrpoving memory and it can be reinforced by other pathways. In fact one sense can revive another circuit and so when we smell a favourite food we get memories of past events. Memory and dreams are similar. Dreams are usually in monochrome and almost always involve vision. Hearing, occasionally and smell, taste, touch almost never. Though the brain is in a standby mode during sleep, it is receptive to input. When a subject is dreaming if input goes in through touch/smell the info is incorporated; vision, hearing and taste are not possible without waking the subject.
Addiction and the amygdala (pleasure point)
Addiction is a reinforced neural pathway involving the amygdala. All addictive behaviour such as alcoholism, drug use, gambling, serial killer, rapist, liar, arsonist can be explained by this theory. Frontal siganls predominate on initial exposure and hesitancy, refusal may occur. Once the frontal inhibition is crossed a neural path is set and that involves the amygdala. Next time the behaviour is reinforced by the amygdala and repetition assigns it to memory. The frontal signal is therefore suppressed and pure amygdala signals take over. That explians the loss of personality in addiction and tendency to ignore responsibilities and complete focus on achieving the stimulation. All other frontal activities are ignored and even basic survival impulse is ignored due to the strong amygdala response. It is a vicious cycle and the more it is done the more it reinforces itself. Now the treatment can target enhancing frontal and other signals or suppressing the amygdala using targetted magnetic suppression/ablation. What other purpose does the amygdala serve? Can it be completely removed in addcits? The result will be a person with no pleasure!
God
Can we conquer the final frontier - our brain?
Man looked in the heavens above and oceans below searching for God. He has always been with us in our brains. God is another emotion like happy, sad, angry, etc. On recurrent use the temporal lobe dominates over all other lobes and so makes a person deeply religious. It should be very difficult to wean such a person away from religion, theoretically atleast. Similarly an atheist should have a poorly developed TL.
I am trying to understand how my own Brain works and so far I am bamboozled!
But I will keep trying and hopefully in my lifetime crack this tough question. Met a guy from Finland who wants to study neurology to use in his study of international political relations. Study one brain to understand how so many brains work (or dont work) together, maybe he has a point...
thinking
is thinking a function of language; if there was no language will we think?
Is time a concept created by the brain? Analogy photo/cinema, are daily events which appear to move actually a series of still instances?
colour is what the brain perceives; there are no colours in realty.
Sound is waht the brain perceives; there are no sounds in realty. The Greek paradox of 'Will a tree falling in a forest make a noise if there is none to hear it?' vindicates this theory.
ghost
why do ghosts come in definite patterns? A ghost in India always wears a white saree, associated with Jasmine and usually also involves delusions of smell, sound and vision (may include touch and rarely taste). A ghost in the western world is always about 100 - 150 years old and wears costumes of that period. Is it because the person who has been conditioned to see a ghost sees what he wants to see? If a child grows up with no concept of a ghost (like me) what would a ghost look like to him?hmm... now who was that behind me?
MMI (man machine interface)
HCI (human computer interaction) is a subset of MMI; how can we interact with a machine intelligently? We dont understand human language development completely so far in 2004. AMESLAN (american sign language) is a good example of a basic language. It is used by people with language problems communicating efectively. It has been used to communicate with apes too. Language = gestures, signs, sounds, smells, touch & pain (high intensity touch), taste, all used in various proportions by different animals. Can we have a universal language? will it be pictorial like the ancient Egyptians (Indians, Mesopotamians, Chinese) had 5500 years ago? Pictures carry much more eficiently a message than words. natural computing can create self learning sytems. What sensory input should it have? Can we have more options than we have (3S2T)?
Subscribe to:
Posts (Atom)