Intussusception

We were able to operatively reduce an intussusception in a nine month old child of a Nepali labourer family. You can read about it on our hospital website.

http://www.manalihospital.com/intussusception/

Working here in this remote area, one finds that one has to have broad based skills and knowledge to handle all types of emergencies. Specialisation and superspecialisation are all very good, but a distant dream and armchair imagining that a remote hospital could ever be adequately staffed by all the necessary superspecialists. Hence the role of the rural surgeon, who has to be competent enough to safely treat the wide variety of cases coming in. Referral from here for any patient would mean an eight hour journey, which could have meant gangrene and loss of viable bowel for this infant.

It is a fond hope that there will be a viable and vibrant rural surgery course that establishes itself in India. The National Board currently conducts the Diplomate course in Rural surgery, but this is not a very popular one as yet.

THE LOST ART OF HEARING – BABEL REVISITED

“Listen to me.”

These words have echoed down timeless hallways of schools and colleges, and are embedded in the minds of countless students. Everyone can remember being encouraged to listen both in classrooms, and at home.

This childhood instruction has  sorrowfully lost its way into adulthood. Adults somehow conveniently forget the art of listening, having discarded it  along with chalkboard, duster or building block toys as an accouterments of childhood.

How often we listen, but don’t hear. Studies conflictingly report that we remember 20 to fifty percent of what we hear. The rest is lost. The ability to listen would involve honing our hearing skills with the following steps:

1.     Paying voluntary attention: Putting aside other things, looking at the speaker, setting aside other things, giving physical feedback with verbal and non verbal signs such as nodding and saying yes.

2.     Actively remembering to file the information received in your mind

3.     Clarifying points that are not understood

4.     Thinking or meditating on what was said.

5.     Replying relevantly

In our nanobyte world, our attention span lasts only 22 seconds before it flits onto some other bit or byte of information now programmed to assault our senses. This  is not conducive to consistent listening.  It encourages a flight of ideas and does not let our mind concentrate constructively on thoughts or patterns, but rather seeks to change them like constantly changing tv screens.

Jesus seemed to know all about this, and in his course of instruction, found the need to reiterate by saying “Truly, truly I say unto you”, almost underlining the necessity for us to listen to what he was saying. Johns gospel records twenty three times he repeated this phrase. He also bemoaned the historical fact that humans, as a race,  tended to listen, but not hear[1].  The solution is in the mind of the hearer, not the speaker, and it is we who need to cultivate the lost art of hearing.

Those who are deaf need hearing aids to augment the sound arriving at the eardrum. Today we are also in need  of techniques to enhance the information arriving at our brains by allowing our senses to intelligently collect the information and allow ourselves to hear what is being spoken.

One habit that we need to actively unlearn is the habit of impatience. We are constantly encouraged to be impatient, as time speeds up our lives. We need quick solutions, fast foods, faster vehicles, and even faster technology as time warps our lives into impatient segments. We tend not involve ourselves in things that call upon us to wait. Hence, when we listen to people, our minds actively want them to finish up what they are saying quickly, and if they take too long, our mind substitutes assumptions which we seem to hear, but are not facts that the speaker is articulating at all. Hence we misinterpret people.  Those speaking to us  are at a loss because we seem to have completely misunderstood and misinterpreted what they were saying.  Those hearing too are mystified because they seem to have heard the speaker saying what they conveniently seemed to hear them say.  All communication becomes cross wired, to the ultimate mystification of society. This is Babel revisited. 

The earlier tower of Babel collapsed because of the use of various languages unintelligible to each other[2]. Todays tower of Babel rises by our not being able to hear the other person speaking to us in the same language. And so our towers keep rising to the sky, artificial constructions doomed by the basic lack of respect for ourselves, for God and for each other.

Would we really want to be part of all this?

How can we choose to change?

It requires active and voluntary replacement of bad habits with good ones, ones that remind ourselves to respect the one who is speaking to us enough to allow them to complete what they are saying prior to interjection or premature rebuttal.  How often we do this, little realizing that this actually stems from a crass indifference and disrespect of others and selfish preoccupation with ourselves.

Active listening requires us to listen to what is being said digesting the information both in terms of content and character, interpreting the emotion and content of speech.

Active listening requires us to clarify with the speaker what they are saying so that there is no miscommunication or misinterpretation.

And it demands a fitting reply from the resources we have to allow meaningful communication and a sharing of ideas, not a indifferent spouting of our own convictions regardless of those listening to us.

This new year, may be learn to be quick to listen, and slow to speak[3].

---

[1] Mathew 13:14

[2] Genesis 11

[3] James 1: 19

Urethroplasty

Read about our patient from Chamba on our hospital website.

http://www.manalihospital.com/urethroplasty/

This patient had promised to be a challenge, but we were most relieved to be able to perform a good procedure on him that will take care of his problem.

The approximating cystourethrogram in this patient had shown a long segment stricture, but on opening, we found a short segment, so were able to mobilise the urethra and obtain a good spatulated anastamosis.  For long segment strictures, the options are more challenging, with either the necessity for extensive urethral mobilisation including crural take down or a buccal mucosal graft. We had gone in prepared for both, but were most relieved to find we did not need it.

When a father dies- a sons perspective

December 16, 2012

A candle flickers

When a father dies.

It does not go out but buffeted

Flames again on an infant son.

Shadows dancing on the walls

Relive memories sculpted in the flesh of time

Drawing blood or tears, or laughter

Or sometimes just a smile

Yesterdays ghouls now have no dread

And fade as starved memories succumb

To peace and quiet stillness

Glazing a once fear fraught face

Laughter echoes in yellowed hallways of time

Merging memories melt and set

As faces smiling flit fondly

Past the windows of its raucous wake

A candle flickered at one souls passage

Night and peace reign ere day

But the tallow still burns brightly

As his children hail a suns new rays

As a father passes further onward

A mantle falls on his son

Weight of passage now unshared

On frail shoulders is feebly borne

Watershed moment, floundering feebly

Searching for strength and faint footing

Memory an unhelpful, reluctant guide through the gloom

Beckons vaguely as a dirge plays

To the hope of another day

Find your feet, forge your way,

Lead your family till that dark day

When your candle will flicker briefly

And your spark passes on

To another’s baton bearing

The heritage of a son.

Demise of my father

Dr. MANGALATH PHILIP ALEXANDER

21^ST September 1930 – 9^th December 2012

Dr. M.P. Alexander was born to a teacher in Chandanapally a village in Kerala. He was one of eleven siblings. From an early age he had an intense drive to study. The fire in him led him to Delhi, PUSA institute where he obtained a gold medal for B.Sc honours and also for M. Sc. Agriculture. He married Ms. Anna Vareed, only child of Dr and Mrs. K.P. Vareed and went with his bride to Ohio State University where he obtained a Ph. D. in cytogenetics in 1961. He returned to take up government service with the ICAR (Indian Council of Agricultural Research) in Coimbatore Sugarcane Breeding Institute.  It was here that Philip his first son, and then Mary Ann, his daughter were born. The family moved to Bangalore where the children were admitted to Bishop Cotton School. The family remained in Bangalore till the children finished their education, which was made possible because he chose to stay in Bangalore by not accepting any further promotions. He retired as the Head of the Pollen Bank which he established in Bangalore. His papers and discoveries are well known and used in the world of agriculture, including a differential stain for pollen which is used worldwide today.

Besides the field of agriculture, he has explored varied and multiple fields each of which he strove for proficiency in and attained a thorough working knowledge. Electronics, Radio and Ham broadcasting, wine making, refrigeration, photography, Sanskrit grammar and writing, poetry, motorbike mechanics, Ayurveda, siddha, computer science, were all fields that he was proficient in. Such  diverse and comprehensive knowledge equipped him to speak with authority on a variety of subjects. Mysticism and religious philosophy were close to his heart as he ventured into areas where very few others would tread.

He had a deep and devoted love for his family, and the passage of his wife in 1994, Christmas day was a great blow to him. He became extremely unwell shortly after and then went to be with his son, in CMC Ludhiana, leaving Mary Ann to hold the fort at home alone in Bangalore.

In Ludhiana, he recovered completely and soon became a regular feature on campus and even in the city as he spent time with all kinds of people, encouraging them and leaving indelible memories of his interactions. He welcomed Anna into the family in 2000 November and had a high esteem and regard for her always. He completely supported his son Philip even when asked whether he would consider moving to the cold and mountainous area of Manali where they felt called to serve. His outgoing and loving nature endeared him to all in Manali where he became a fond fixture in the marketplace, where he used to go on his daily rounds of visits.

Over the past eight years, though his health remained well despite one episode of hospitalization for pneumonia in 2010, age and his smoking habit began to pay a toll on his lungs. His marketplace visits decreased as he found it difficult to move about freely without becoming short of breath. His interests continued to flourish indoors as he became proficient with the computer and linked his satellite tv and built a finely tuned music system, on which he enjoyed listening to old classic hindi songs and watching movies. The arrival of his grandson was a source of great joy to him and he took pride in drawing attention to the intelligence of Nathaniel. A hallmark of his day was a daily morning email to his daughter Mary Ann who was married and in Finland.

He fell coming out of the bathroom on the 14^th of November, and though he walked in the morning and afternoon, found himself unable to get out of bed in the afternoon. An x ray done showed a fracture of the right femur. He was moved to CMC Ludhiana by ambulance where further investigations revealed a cancer of his right lung. He underwent a partial hip replacement on the 19^th, a procedure which he tolerated very well and was ready for transport back to Manali in a week. In Manali hospital he recovered well and was looked after and cared for very well by all the staff. He was brought back home capable of standing and sitting with help, on the 8^th of December 2012.

On the 9^th December, Sunday, he watched the passion of Christ in the morning, had lasagnia for lunch which Anna his daughter in law made for him, slept, and in the evening ate a piece of cake from his grandson’s hands. The celebration of his grandsons second birthday was delayed for this homecoming. In the night however, he suddenly developed breathing difficulty. He asked for prayer, he prayed, and surrounded by his family, went peacefully to be with the Lord with a half smile on his face.

He was buried in the campus of the Mission hospital, after a funeral service which packed the church in Manali. A memorial service was held on the 13^th, which was so well attended that there was no room to sit in the church.

He will always be remembered fondly by all as a brilliant man with a heart big enough to love one and all leaving indelible memories of his interactions. His drive to study and get young ones to study will continue to inspire many.

We thank God for his life.