International Medical University

By Ravi Shankar

Zhi-Khro mandala, a part of the *Bardo Thodol’s* collection, a text known in the West as *The Tibetan Book of the Dead*, which comprises part of a group of bardo teachings which originated with guru Padmasambhava in the 8th Century. Courtesy: Creative Commons

My friend, Dr Ramesh Kumaran first shared the shocking news with me on WhatsApp. Along with a recent photo, the caption mentioned ‘Mourning the sudden and untimely of our dear Joseph Francis (6^th batch). May his soul rest in peace. 6^th October 2022.’ I felt sick in the pit of my stomach. This was the first mortality among our MBBS batch mates. One of our friends died when he was studying for MBBS, but he had left the course and was suffering from a prolonged illness. Some of our batch mates had close encounters with death during the ongoing COVID-19 pandemic.

I was reminded of my own mortality and the fact that we often forget that our time on earth is limited. None of us know when exactly or how we will die. This I believe is a good thing. Movies have explored the sad state of people who knew or supposed they knew when and how they would die. Humans stride through life assuming their immortality. We kill fellow humans indiscriminately. We learn to hate each other. We pursue wealth and power. When we leave our material existence on Earth, we can take none of the accumulated wealth and power with us. The ancient Egyptians believed otherwise and buried their Pharaohs with all they would need in the afterlife. Ordinary people had no such privileges. We do not know much about the afterlife. Here science ends and we enter the realm of religion.

I facilitated a module on Death and Dying for medical and other students and our ignorance about death is profound. Modern medicine has the motto of preserving life regardless of its quality. We have not been trained to let go and make a person’s remaining time on Earth worthwhile. This is slowly changing but change is slow. We do not live life assuming that any moment can be our last on Earth. The Tibetan Book of the Dead (Bardo Thodol) tells us to live each moment in a spiritually fulfilling manner and mentions that we all have the potential to break free from the cycle of reincarnation and become spiritually enlightened beings.

I first met Joseph when I joined the Men’s hostel and the undergraduate medical (MBBS) course at Thrissur, Kerala, India. Our seniors were prowling around our floor abusing us and one of my friends was crying as he had just been forced to take off his moustache. Ragging still exists in India and students who were abused by their seniors wait for the new intake to take revenge. You are not able to take revenge on the powerful, so you take out your anger on the powerless. We see this all around in the modern world.

Joseph stayed in a room near mine, and we became friends though not extremely close. One of the things I still remember about him is that he used to write with a fountain pen and used black ink. Even in those days when writing was still common most of us used ballpoint pens. He had impeccable handwriting. Joseph was always a perfect gentleman and willing to help others. I believe we did a few of our internship postings together. We collaborated on skits and other presentations during the college day celebrations. I still remember our college trip to Trivandrum Medical College for the Intermedicos festival and we stayed and slept in the badminton court inside the Men’s hostel. Life was simpler in those days. We were beginning to see the end of the MBBS doctor and specialisation, and super specialisation was becoming common. I feel this is a sad development and an MBBS doctor is competent to treat most illnesses. In fact, evidence shows that most illnesses can be handled by a trained paramedic. In most European countries, care is mostly delivered by general physicians while in the United States care is mostly provided by specialists. The amount spent and the health status of these countries/regions tell their own story.

During those days, failure in MBBS examinations was common. Anatomy at the end of the first MBBS and Medicine at the end of the Final MBBS had the maximum casualties. Grading was arbitrary and there were no clear rubrics to guide the scoring. I was lucky to have squeaked through the anatomy dissection and the medicine courses. Joseph was unlucky and mentioned this often as due to his failures, he could not appear for the entrance exam of PGIMER[1], Chandigarh, one of the top postgraduate institutes in the country. One could not appear for the entrance exams failing the MBBS. A lot of effort has gone globally into changing the assessment system in MBBS and making it fairer and more objective.

Joseph used to join us for an occasional game of basketball. I next met him at Ollur, near Thrissur, when I was doing my post-graduation. St Vincent de Paul hospital was a multi-specialty hospital. I had come down to Kerala for a few days and stayed with Job and Joseph, both medical officers with who I shared a large apartment.

Over the years I lost touch with Joseph, and I next interacted with him in 2018 when I joined a WhatsApp group of my classmates. Joseph was very active in the group and was working as an anaesthesiologist in the United Kingdom. Many of my batchmates were working in National Health Service (NHS) and they often would mention how the NHS is being steadily starved of funds. The COVID pandemic hit the medical community hard. Doctors in practice seem to be especially vulnerable. We discussed this and postulated that it could be because they are exposed to repeated doses of the virus in high concentrations from multiple patients. Many doctors had lost their lives; many others I know were in the Intensive Care Unit for prolonged periods of time. Two of my classmates in the UK had serious illnesses requiring hospitalisation and prolonged intensive care.

I next interacted with Joseph when I was unable to make a bank transfer to the UK to pay for membership fees of a professional organisation. The transfer was not going through and eventually, I asked Joseph if he could do the transfer from his account in the UK, and I would deposit the money in his account in India. He readily agreed. Joseph was always very helpful. During the last two years, I have lost several friends. Two academic collaborators, one in Malaysia and the other in Yemen passed away. Colleagues I knew in Nepal died due to COVID complications.

Death can be a celebration of a person’s life. An Irish wake is one last party to honour the deceased. Unknown diseases plagued the Irish countryside causing a person to appear dead. Hence a person would be waked in the deceased’s home for at least one night. I had the exact fear while certifying death. What if the person then woke up and disputed my certification? I was very careful and meticulous while writing out a death certificate.

These deaths have underscored my own mortality. As someone once said, death and taxes are inevitable. Accepting one’s own mortality and coming to terms with our eventual demise makes you aware of the folly of chasing power and glory and can contribute toward a gentler, more decent world. Climate change is a testament to human greed and folly. We are still uncertain how liveable Earth will be during the next hundred years. As Mahatma Gandhi said, we can satisfy human needs, but we cannot satisfy human greed!

[1] Postgraduate Institute of Medical Education and Research

Dr. P Ravi Shankar is a faculty member at the IMU Centre for Education (ICE), International Medical University, Kuala Lumpur, Malaysia. He enjoys traveling and is a creative writer and photographer.

PLEASE NOTE: ARTICLES CAN ONLY BE REPRODUCED IN OTHER SITES WITH DUE ACKNOWLEDGEMENT TO BORDERLESS JOURNAL

Captain Andi is in love

By Dr. P Ravi Shankar

The bubbly lyrics of Bobby McFerrin’s song ‘Don’t worry be happy’ filled the room. Andi was awakened from his slumber and slowly opened his eyes. He glanced at the clock by the bedside. Five a.m. Still dark outside. He had a virtual clinical exam later that morning. Early to bed and early to rise in the good old armed forces tradition was always mentioned by his mentor. Though with the heavy course workload and multiple assignments on most days he did not hit the bed before 11 pm.

His artificial intelligence (AI) mentor carefully monitored his academic progress. He was a straight A student and had done very well through the duration of the course, which was partially done. He was doing an accelerated curriculum and was expected to graduate in about two years. After his morning ablutions, his home robot came with a steaming hot cup of coffee. Dark and strong just the way he liked it. The robot checked his physical parameters. There were several sensors implanted in his body monitoring in real-time his physical parameters. Everything seemed normal and there was no cause for alarm.

He was one of the twenty students who had joined the undergraduate medical program at the Armed Forces medical school a year ago. He was inducted at the rank of Captain. Now the army and other organisations did not require many doctors. AI systems did most of the work of diagnosing and treating patients. AI was ubiquitous and omnipresent. Systems drove trucks, public transportation, private transportation, flew planes, did all menial jobs, carried out all secretarial and clerical jobs and took care of and educated human children. He had a special interest in human history and recalled the history lessons he had taken at school. During the mid-twenty-first century AI began to dominate life and most humans had slowly but steadily lost their jobs. Some were able to retrain and readapt and started helping in building and educating AI systems. The wars and the heating of the planet had reduced the liveable land. Human population steadily decreased for the first time in several centuries.

Frequent pandemics had become a regular part of life. Or rather was it the same pandemic which never really went away? A certain degree of control and protection was afforded by vaccines, but the virus had become endemic. Humans were resilient and had adapted to the new normal. New strains were isolated regularly, and these required a new set of vaccines to be developed and another round of vaccination. Luckily vaccines were edible these days and incorporated in tasty fruits like bananas.

Maya was his classmate. A perky and slender dark-haired girl, she never failed to cheer him up. He would be meeting her in about an hour. He read through his notes and prepared for the day ahead. He had a special interest in cyborgs and in enhancement of human function. Medicine had developed so much since the Middle Ages. He would be having a class on the ethics of incorporating AI systems in medicine in the morning by Prof Kim. He enjoyed Prof Kim’s sessions. All sessions these days were virtual except the ones on clinical skills. Most patients interacted with their doctors virtually. The sensors implanted on each human meant changes could be identified early and diseases addressed at the incipient stage. He and his fellow students and the teacher interacted virtually using a mix of extended reality and holographic images. The world had shifted online.

The world was a huge web. The internet of things. Devices and persons communicated constantly. Life was good, was it not? Why did he get the creepy feeling that he was being monitored all the time? Was he ever really alone? His father had made a fortune building sea walls and protecting coastal cities from the rising seas. The sea level had risen by over two feet and sea walls were a necessity. The Dutch were the masters and had made a huge fortune keeping the world from drowning. Human germ cell DNA editing was routine — both to eliminate deadly genetic diseases and to enhance human capabilities.

Nearly everyone had some sort of enhancements done to their body to improve their hearing, vision, physical endurance, and immunity among other things. Surviving in the hostile world without an enhanced immune system was impossible. Occasionally he got together physically with his batchmates in the informal learning spaces the college provided. They were an even split. Ten humans with enhancements and ten living AI machines. Life had taken on a whole new meaning with the advent of machine life.

Machine life had several advantages. They were stronger, had almost superhuman powers and were immune to the viruses and other microbes in the air. Occasionally some parts needed to be replaced or some enhancements carried out. They did not need to sleep, and neither were they ever bored and unfocused. In medicine the machines had anthropomorphic features. They looked like humans and from their external appearance only it had become difficult to know if someone was a machine or a human.

Humankind was pursuing immortality. Most lived nearly three hundred years. Rich individuals could download their memories into AI systems and become immortal. The memories could be slowly downloaded at intervals into a developing human and a person could live life both in the virtual and the real worlds. Dr Cerson was a famous surgeon of the twentieth century, and his memories were being slowly downloaded into Captain Andi. Cerson’s ‘soul’ had passed through several human bodies during the ensuing centuries learning and adapting to the brave new world in the process. Surgery today was fully robotic and used an army of micro and nano-bots to carry out the procedure precisely and with nearly no tissue damage.

Maya was a humanoid — machine life. He recalled the day she had told him about herself in the college cafeteria. She knew he was developing tender feelings for her. Machines were built to detect and respond to human emotions. Human-machine intimate relationships were not expressly forbidden but neither were they encouraged by the government. There were a host of problems though the machines were built to be empathetic and kind to humans. The machines did not require sleep, no babies resulted from the relationship and one of the partners was immortal. He had given a lot of thought to these issues but eventually decided to go ahead with his relationship with Maya. He would be moving into her house in a week so that they could sync forces and optimise performance. He started humming the opening lyrics of the classic love song sung by George Benson ‘Nothing’s gonna change my love for you’ as he got dressed for his trip to the college cafeteria and coffee with Maya.

PLEASE NOTE: ARTICLES CAN ONLY BE REPRODUCED IN OTHER SITES WITH DUE ACKNOWLEDGEMENT TO BORDERLESS JOURNAL