Tag: MBBS

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Slices from Life

Hooked for Life and Beyond…

By Ravi Shankar

I was hooked! It was my first exposure to a computer though I had read about these in the newspapers and seen them on television. I think it was a Spectrum personal computer popular in the 1980s. My friend, Sanjay and I did a few simple tasks and played a few games on the computer. The games of the 80’s were slow and clunky by today’s standards. In those days however they were interesting and enticing. BASIC was the most popular computer language then. We also had COBOL and a few others. My good friend, Sanjay Mhatre was a bibliophile and a free thinker, and I often used to visit his place and borrow from his vast book collection. However, even in the 1980s there was uneasiness and opposition to computers and the fear that it would replace people and lead to mass unemployment was often mentioned.

The rise of information technology (IT) and the important role to be played by Indian companies was still in the future. I expect artificial intelligence (AI) will also open new jobs in the future. At my medical college in Thrissur, Kerala, India computers were still rare. Communist Kerala had a love-hate relationship with computers and technology. Maharashtra (a western Indian state) was an early adopter of computers, and my tenth- and twelfth-mark sheets were computerised while my MBBS ones were handwritten. During my postgraduation at Chandigarh, computers gained prominence in our conversations. Our head of the department was gracious enough to offer the services of his secretary for typing our research manuscripts when she was free. The only other option was to pay for the service from outside providers. In those days WordStar and WordPerfect dominated word processing. 

Creating slides for presentations was a challenge. LCD projectors were not available, and we had to create physical slides with cardboard mounting. The slides were created on early versions of PowerPoint and photographed using a camera to create the physical ones. My co-guide, Dr Anil Grover (then a cardiologist) at Postgraduate Institute (PGI), Chandigarh mentioned how computers will become increasingly common and encouraged me to learn the Microsoft package of Word, PowerPoint, and Excel. PGI also started offering email facility on a limited basis. You had to write down the details of your email and take it to the IT section who will send your message. We had modems then, which took a while to connect and made a series of sounds with flashing lights while connecting to the internet.

In Pokhara, Nepal at the beginning of the twenty-first century, internet was still a luxury. Manipal College of Medical Sciences used to charge 10 Nepalese rupees to send a message. Faculty could type their message in Outlook and twice a day, the IT person would send and receive messages. In those days, a floppy disk was the most common external storage device, and I soon had a large and colourful collection of floppies. Floppies were not always reliable and sometimes the data on them could not be read. CD-ROMs were another storage device, but CD writers never became commonplace. At Mahendra Pul in the heart of Pokhara, a new cybercafé came up in the early 2000s offering internet browsing at 150 Nepalese rupees per hour. Compared to what we were previously paying, this was a steal!

The college also had an LCD projector though it was not commonly used by faculty members for teaching-learning. This was a large and clunky device. Earlier versions often had compatibility issues. You create your slides and hope for the best. These may or may not open on the laptop and may or may not be projected. One had to have a backup of the lecture on overhead projector (OHP) transparencies, just in case. We did not yet have easy access to computers or laptops. This came only later when the United States Pharmacopeia (USP) set up a drug information and pharmacovigilance centre at the teaching hospital. We got two excellent Dell computers, and the hospital provided us with internet.

The early computers were slow with a big, bulky, and heavy cathode ray screen. They had a blinking cursor and words appeared slowly after typing. The Hollywood movie, You’ve Got Mail (1998), follows the romance between Meg Ryan and Tom Hanks developed through email. The movie is a good introduction to the early days of the internet.  

We had purchased a home desktop computer in 2001 or 2002. This purchase was a financial disaster. The computer required frequent repairs and drained our finances. Google launched its beta version of email, Gmail in 2004, and I was one of the early adapters. I became a fan of Gmail right from the start. It offered significant advantages over the then dominant Hotmail, Yahoo mail and Rediff mail. The storage was larger and there was no need to delete your old emails. Kist Medical College in Lalitpur, Nepal had purchased Dell desktop computers, and these were among the best ones I had used. Fast and responsive with good memory and speed. These had LCD monitors and looked sleek and modern.  

Computer technology has made significant advances. I read that if cars had made similar advances to computers we could drive to the moon and back on a litre of gasoline. Chips started getting smaller and more powerful and are today fought over by the global technology superpowers. A variety of online applications started making their appearance with the spread of the internet. Some of these eventually became the internet giants of today. In India, internet became widely available, and the costs dropped significantly. Mobile technology also made dramatic advances. In India most people access the internet and carry out online tasks using their mobile phones. For around 12000 Indian rupees today you can get a decent mid-range phone. Today mobiles in the palm of your hands have greater processing power than the giants of the 1950s and 1960s. I remember reading a comic strip where a visitor from the future time travels to the present. He laughs on seeing the supercomputer, the most powerful one on earth. When asked why he shows a small ball and introduces it as a computer from his time with much greater processing power than the humungous supercomputer.

One of the major advances has been cloud computing and cloud services. We have Chromebooks that work on web-based applications and needs the internet to do things. Both Google and Microsoft offer a range of services including storage, meetings, messaging, and applications for text, presentations, and calculations. AI is now an integral part of applications. PowerPoint offers the designer option for slides and creates stunning backgrounds. I recently attended a workshop on Copilot, the AI support software from Microsoft that is fully integrated into all their applications. I like the transcribing option for interviews and focus groups offered by Teams and later by Zoom and this makes my life as a researcher easier.

Star Trek, Futuristic computing

When I was growing up, I had no clue about what would soon become commonplace. The world wide web, the ability to browse libraries and art collections, video conferencing, online work processes, applying for government and other services online, online fund transfer and remittance are now at our fingertips. The COVID pandemic shifted a lot of learning and even assessment online. Presently we mainly interact with computers using a keyboard. I am a fan of the sci-fi series, Star Trek, where people interact with computers mainly using their voice. Voice commands are already available and  steadily improving.

I was slow getting into social media. Their judicious use is to be recommended. Facebook keeps me updated on what my friends, acquaintances and former students are doing. LinkedIn is the professional face I present to the world, Twitter (now X) is a concise way to stay connected and YouTube is a major source of entertainment. Computers have changed our life for ever. At a basic level these are based on the flow of electrons through circuits and on the pioneering work in atomic physics done at the start of the twentieth century.

The last three decades have seen developments and changes at unimaginable speed. Who knows what the next three will bring? Will progress continue at an ever-accelerating pace or will we eventually hit a roadblock? We may have to wait for Father Time to provide the answers!

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.

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

Click here to access the Borderless anthology, Monalisa No Longer Smiles

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Nostalgia

My Hostel Days

By Ravi Shankar

The air was getting colder. There was an early morning chill. I wrapped my cotton blanket more tightly around me. January is one of the colder months of the year in Thrissur, Kerala, India. During winter and summer, I had taken to sleeping on the terrace of the men’s hostel. More peaceful and soothing. You can watch the twinkling stars and the clouds. A few other kindred souls did the same. Though it did rain on occasions and then we had to beat a hasty retreat with our bed rolls. The terrace also attracted students who studied using their table lamps till the small hours of the morning.

I stayed at the same hostel room throughout my undergraduate medical (MBBS) course and the first month of my internship. I still remember my entry into the men’s hostel. I had a big suitcase, a bedding roll, a table lamp, a plastic bucket, a mug, and a few daily necessities. We were allotted the first floor of the C Block called the C’ block. We were the sixth batch of the institution and the last one to enjoy the privilege of being allotted rooms together in a single block. Of the twelve rooms in C’ all except three were allotted to our batch.

Ragging was still going strong though strong anti-ragging efforts were also ongoing. We had security guards posted at the entrance to our block and our seniors screaming abuse at us. Gradually after the first few weeks, things quietened down. Reminiscing about those days, I am struck by the simplicity of our lives. Each room had two windows, a ceiling fan, three wooden tables with three wooden chairs, three wooden cots, three metallic cloth hangers, and concrete wall shelves. There was also a ventilator opening into the corridor. Each room was shared by three students. The older medical college hostels had high roofs and did not always have a ceiling fan.

The men’s hostel was located at the edge of the vast campus of the Medical College, Thrissur. There were three blocks (A, B and C) with each block spread over two floors. There was a big portico in front with a phone room and a phone boy. There were bigger rooms (with attached baths) for the tutors and a TV room on the first floor. We had an improvised gym on the ground floor. A room for indoor games was on the first floor next to the TV room and the hostel mess was on the ground floor. In those days there were no cell phones and subscriber trunk dialling (STD) was not yet available. Trunk calls had to be booked manually. The newspaper and magazines room were right at the hostel entrance.  

The mess was a simple affair with eight wooden tables and wooden stools and chairs. The chairs had to be strong enough to withstand frequent abuse from the students. There was a serving window, and the main kitchen was inside. Mornings were busy as the clinical students had to board the college buses to reach the hospitals in the town. We had a varied menu for breakfast. This could be masala dosa (a flat bread of rice and lentil flours stuffed with vegetables) puttu (steamed cylinders of ground rice, layered with coconut shavings and fillings), idli (a savoury rice cake), upma (a thick porridge made from rice flour or semolina), noolputtu (called string hoppers in Sri Lanka), bread with jam and butter and something that we called the fractional test meal (FTM). FTM consisted of a glass of warm milk, two boiled plantains and two hard boiled eggs. Quite nutritious and filling. Lunch was usually a hurried affair except on Sundays. Afternoon tea or coffee was one of my favourite repasts. Kerala has a rich and varied selection ranging from different types of vadas (savoury fried snacks), adas (fresh coconut and jaggery wrapped in a dough made of rice) steamed in banana leaf, cutlets, pazhampori (fried banana fritters) and something we called the grenade. The grenade was shaped like one, was mildly sweet and required some effort eating. Neither the mess tea nor coffee were remarkable.   

Hostel mess. Photo courtesy: Ravi Shankar

The quality of dinner varied greatly. On the menu could be chappati (unleavened flat bread), Kerala parotta (layered bread), biryani, plain rice among others. People from the central parts of the state were fond of kanji (a rice gruel). Each month we selected three mess secretaries to oversee the mess. Later we started having a dinner feast toward the end of the month with a grand menu. I still fondly remember the biryani and the lime juice. Lime juice is a specialty of the area with a beautiful blend of sourness and sweetness. We had the Indian Coffee House (ICH) run the college canteen off and on. They closed and reopened a number of times. The crowd we had was not enough for their operation? They served masala dosas with a stuffing of beetroot and potatoes, cutlets, and strong rich coffee. Economics restricted this outing to may be once a week. I survived on a monthly money order from my family.

We also had a local tea shop run by an old people a five-minute walk from the hostel. We used to drop in there during the evening for tea, coffee, and snacks. They also occasionally served lunch. The lunch was served on banana leaves and consisted of papadam, injipulli (dark brown sweet-sour and spicy curry made of ginger, tamarind, green chillies and jaggery), vegetables, sambar (a lentil-based vegetable stew), rasam (a spicy South Indian soup-like dish) and fish curry and fish fry as an extra. The fish was mackerel coated in a spicy rich coconut coating and deep fried in coconut oil. During the early days the mess had frequent financial difficulties resulting in closure and we had to hunt for food outside. Luckily there were a few local tea shops around the campus though this often required a long walk. This was challenging especially at night. Eventually the situation stabilized, and closures, luckily became rare. We also had water problems before we were connected to the main water supply. We were dependent on a small pond, which used to dry up during the summer. The mess had a huge water storage container placed near the wash basins in case the taps run dry.    

The medical college campus was the old TB sanatorium. The sanatorium was established several decades ago far away from human habitations. The campus was vast, and the soil rocky. There were a lot of cashew trees on the sprawling campus. Soon campus roads were constructed, and we could walk move about more easily amidst nature. The basketball and the badminton courts were closed to the hostel and were packed during the evenings. Summers were hot though the temperature was usually below 40 Celsius. Now summer temperatures are routinely over 40 degrees throughout much of Kerala. The state is facing the full brunt of global warming.

We organised a hostel day only once during the time I was at the college. That was a grand affair with music and dancing and several courses of food. The ground in front of the hostel was converted into a fairyland with twinkling lights and decorations. We had a system of ‘late mess’ where dinner was stored for us till 10 pm. We often used this service when we went to watch movies in Thrissur town. The bus fare then was below two rupees and now it is around twenty rupees.

We used to enjoy long walks in the sprawling campus and through the by lanes of surrounding villages. Life was very stressful with assignments, submissions, and frequent examinations. We had to find creative means to relax and recharge. I still remember my last week at the hostel. I was doing my posting in the hospital at Thrissur town and decided to shift to a lodge at the town outskirts. I had accumulated several medical textbooks during my study years, and these were heavy and had to be transported safely. Carrying these around required brute physical effort. You had to be physically strong to be a doctor. I developed close links with my room mates and my floor mates during my stay at the Men’s Hostel (MH). These are nurtured and maintained through our batch WhatsApp group. At my alma mater each batch is named after a famous personality in medicine. As I read more about Osler and his stellar contributions to medicine I felt justly proud that our batch carry his illustrious name. MH, Medical College, Trichur you have left an indelible mark on me and my fellow hostelers. MH tujhe salam[1]!    

[1] Salute to you.

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.

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

Click here to access the Borderless anthology, Monalisa No Longer Smiles

Click here to access Monalisa No Longer Smiles on Kindle Amazon International

Categories
Slices from Life

The Death of a Doctor

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 (6th batch). May his soul rest in peace. 6th 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!  

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[1] Postgraduate Institute of Medical Education and Research

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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.

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