Anand Bharathan

My wife’s brother came visiting us this morning. This is the first time in the last 25 years that we are getting to meet him. He spoke about his life’s journey which started as a student of journalism and blossomed into his Professorship in academia, teaching and training people in a specialty called “Instruction Technology” at Kansas, USA.

Mathematics

As I was wondering what this field is about, he explained that “instruction technology” integrates online academic teaching at schools/colleges and software technology in such a way that the “end-user” or the “intended beneficiary” (read students!) becomes the most important beneficary of the two components of online teaching resources, viz. teachers and the technology they use. It was wonderful to listen to his journey of imagining himself to be a poor mathematics student, starting a career in journalism & content creation, meeting a teacher at Singapore who inspired him to take up GRE (an exam full of mathematics!), scoring very high in maths based GRE- fully unravelling the fact that the right teacher could bring out the true potential, of even a student who imagines himself to be poor at something and showing how destiny unravels itself as one starts travelling into the “unknown”, letting go of the fear that is so characteristic of, and paralyses so many of us.

Gratitude

He spoke about gratitude as he continued. My understanding of gratitude was that it was of vital importance to recognise the contribution of other people in our lives. Something that will genuinely make them happy and encourage them to continue to help other people. I truly did not know how it worked.

Deepak anna told me that gratitude was of vital importance to ourselves as individuals. Gratitude allows us to have a photograph of the many positive events of life, as we experienced it. That life allowed us to have so many positive experiences. It shows how the person or people or a life-situation to whom/which we are grateful was so vital to our own experience of those positive moments. So, he told that gratitude is something we must show, to help ourselves first. Of course, expression of gratitude will certainly make the other person experience happiness and make her/him want to help more beings around them.

I was astonished at his very high level of understanding of how gratitude works. And, of course, immediately was filled with gratitude for him.

Forgiveness

Deepak anna also completely changed my understanding of forgiveness. I used to believe that only strong people know how to forgive others who did something wrong to them. That you could transmute your enemies to friends by learning to forgive. That we need to forgive ourselves, for our own mistakes before we could forgive others. Many such ideas existed in my mind about forgiveness- from what I read, heard and knew.

Whereas Deepak anna told that we ourselves are the greatest beneficiaries when we offer forgiveness to others. When we truly forgive someone, we let go of the burden we carry in our mind, our baggage, about them. About a bad feeling we have about them. Any bad thought or feeling about any other soul is truly a burden. A burden which is waiting to translate into a “re-action” to the harm we think that they caused us. It is so easy to for me to understand now that forgiveness is a way of easing our own burden. Of strengthening our “letting go” muscle. This will empower us to breathe easy, walk away easily from people and life-situations that have the potential to trap us into an endless cycle of harm and counter-harm.

I am so grateful for this day and for Deepak anna who took time to come visit us in his limited time in India.

Lessons from a young woman with blood vomiting

Mrs. Keerthana a 24 year old woman and mother of a 1 year old kid, suddenly started vomiting large amounts of blood as she was feeding her child in chawl they lived in Mumbai. Her husband, a daily wage labourer in Mumbai took her to a hospital near by where she was stabilised, was diagnosed to have “Extrahepatic Portal Vein Obstruction (EHPVO) and then given a referral to see a senior multi organ transplant surgeon at a private hospital in Mumbai. She was also diagnosed to have Protein-C deficiency, a condition that leads to excessive and unwarranted clotting of blood vessels in her body. In her case, portal vein that takes blood flow to liver was blocked. They were scared of the expenses that will ensue. They knew that one of the city’s public funded corporation hospitals, KEM hospital would offer them care at no cost. But decided to travel to the comfort of their home town, Salem to have the family’s support in this difficult time.

Keerthana’s family knew, Dr. Devaprasath, Pediatric Cardiolgist of Sri Ramakrishna hospital where our team serves in Coimbatore. He called up to ask if there is a surgical procedure that would help and to say that they cannot spend much.

When we saw her in our clinic, we saw a thin built woman who desperately wanted to live and was very scared that another episode of such blood vomiting would kill her. EHPVO, from which she was suffering occurs due to blockage of a large blood vessel called portal vein which drains blood from spleen and intestines into the liver. This blood vessel supplies 80% of blood inflow to the liver. Portal vein’s blood carries nutrients absorbed by intestine and insulin/glucagon produced by pancreas to the liver. When this vessel is blocked, blood from spleen/intestines goes back to heart via alternate channels in our oesophagus and stomach. These tiny blood vessels are not designed to carry that much blood (about 1.5 litres/minute) and so rupture causing blood vomiting.

Our medical gastroenterologist, Dr. Murugesh promptly performed an upper GI endoscopy for Keerthana and found large, high risk oesophageal varies with signs of recent haemorrhage (SRH). He performed endoscopic variceal band ligation (EVBL), a procedure that would help prevent another immediate episode of blood vomiting. Our clinical assessment informed us that she will benefit by an operation called “Proximal Spleno Renal Shunt (PSRS). In this operation, we remove the spleen, mobilise the splenic vein from the pancreas (to which it is closely adherent) and connect the splenic vein to the left renal vein (which takes blood from left kidney to the heart). The operation will decompress the portal blood flow into the left renal vein thereby preventing further episodes of blood vomiting. Alternate option is to perform endoscopic procedures repeatedly over several months. Such treatment will not allow Keerthana to undergo recovery quickly and will mandate multiple hospital visits, sometimes with only an incomplete recovery. In our practice, we believe that PSRS provides a highly reliable one time surgical procedure for this condition, allowing patients to return to their job/place of work/reunion with family very quickly. We have seen that PSRS operation results in reduction of costs as it is a one-step procedure. The alternate endoscopic treatment is associated with repeated hospital visits, tests done every time, multiple procedures/their associated costs and loss of working days for the patients and their family members who accompany them to hospitals.

The operation would cost a substantial sum of money for this poor family. We advised them to go to the surgical gastroenterology service of Government Stanley Hospital at Chennai where the operation could be done free of cost. But, Keerthana and her family told us that this was their last destination. They were tired and sick of running around. They were scared of the long waiting times in government systems. And, we knew that she had a surgically curable condition. We accepted her for the operation which was successfully performed by our team. Lead surgeon for this operation in our team was Dr. R. Jayapal, whose training at AIIMS, New Delhi gave him a substantial exposure to this rare operation. The hospital supported her by waiving all fees for all the operating surgeons and taking only the bare minimum cost needed to care for her. Keerthana made an uneventful recovery and has now been discharged from the hospital.

We spoke to her family to ask as to how they managed to pay the bills that were minimum due for the hospital. They had borrowed money for 60% interest! We were able to return about 20% of the sum paid by them luckily.

Lessons we learnt

Private health care is expensive. I increasingly find a lot of private hospitals and doctors working there who understand and support the plight of patients who are financially marginal.
People chose to undergo operations in private sector not because they can afford them, but for many social reasons, that include long waiting time.
They borrow substantial amounts of money for care.
Interest rates for borrowing are obscene in our country even in year 2023. In Keerthana’s case, interest rate was 60%.
Family would take about 2-3 years to repay this money.