Cell 2 Soul: The Humane Health Care Blog

On Pride and the Struggle

There’s an old French saying: to cure sometimes, to relieve often, to comfort always.  It could serve a mantra for all health care professionals. It reminds us that it can be more important to treat the person who has the disease than it is to treat the disease the person has.

Two recent vignettes were sent to us that illustrate these points.

Croina’s Pride by James Channing Shaw and

My Struggle by Lee Thompson

Both provide valuable insights for patients, their families and all care givers.

They appear in The Online Journal of Community and Person-Centered Dermatology (OJCPCD), a free, post-publication peer-reviewed, full text, open-access, online publication.

Depressed but Not Ashamed

by Madeline Halpert and Eva Rosenfeld,
NY Times, May 21, 2014
The authors of this NY Times Opinion piece are managing editors at their high school newspaper in Michigan.

"Most of our closest friends didn’t know that we struggled with depression. It just wasn’t something we discussed with our high school classmates. We found that we both had taken Prozac only when one of us caught a glimpse of a prescription bottle in a suitcase during a journalism conference last November. For the first time, we openly discussed our feelings and our use of antidepressants with someone who could relate. We took a risk sharing our experiences with depression, but in our honesty, we found a support system. We knew we had to take the idea further."

Full Opinion Piece in the Times

Here’s an article with background information on “Depressed but Not Ashamed.

The Wonder Years

by P. Ravi Shankar

PDF for easy reading: Download The wonder years

The house was old but had personality! The small space in front paved with red rectangular tiles, the arched doorway with red bougainvilleas growing in riotous profusion, the well by the side and the small garage filled with sand. White jasmine bushes wafted their heady scent into the night air filling the house with an intoxicating fragrance. The drawing room and the kitchen, the nerve centers of the house adjoined each other. My father used to always say that this arrangement ensured that the ladies of the house could keep an eye on the main entrance from the kitchen. The drawing room had wooden windows with colored glass panes. Dark blue, green, and violet panes tinted the entering light in rich colors. The roof had wooden rafters and the floor was a dark, warm, rich red.  There was a wooden showcase encasing a beautiful image of Lord Krishna which used to dominate the room. In the modern era the LCD television has pride of place in most drawing rooms and sadly the same has occurred in my father’s ancestral home.  

My grandmother was a remarkable woman. She was small, around five feet one; as she aged her spine gently curved dragging her closer to Mother Earth. She was always immaculately dressed in white and was perpetually busy with household matters. She was a matriculate under the old British system and used English precisely and succinctly. She had studied in Moyan Girls High School in Palakkad, Kerala during the 1920s and 30s and it was a strange quirk of fate that over sixty years later I appeared for the medical entrance exam successfully at the same school where my grandmother had studied.        

Adjoining the drawing room was a store room, a place I used to dread as a child. Palakkad was still an agricultural town and we used to keep our pesticide spraying equipment there. The bright copper container, the long snaking tube and the wide spraying nozzle used to terrify me. I remember quickening my steps when passing nearby and turning my head to the other side trying my level best to avoid looking into the dark and dangerous room. Inside, the house was dark and cool like old houses everywhere. I had heard my grandmother describe her purchase of an old mud house in the 1940s and remodeling it to the present structure. In the center of the house was a room surrounded by verandas. The room had a large circular table and some shiny old trunks which my grandmother had bought back with her on her return from Malaysia. The room had a hinged trapdoor in the roof which opened to the dark attic.

I was both fascinated by and scared of the attic. It was dark, low and filled with soot. There was a musty odor. The attic was full of old ‘things’ which my grandmother had collected over the years. There was a rich and eclectic collection of books and odds and ends. The dark rooms had wooden almirahs with glass mirrors. These were painted a rich, chestnut brown. The doors in the house were thick and heavy requiring considerable expenditure of effort to open and close. The doors had wooden doorsteps and you had to high-step these while going from one room to another. I often forget about this impediment to progress and used to crash heavily against the doorsteps.

The ‘other side’ of the house was my favorite with two large rooms and a dining room and kitchen. The two bedrooms had wooden windows which opened on a small coconut grove. The high wooden beds were richly carved. I have always been fascinated by coconut trees which I subconsciously associate with Kerala, God’s own country. The green fronds gently swaying in the breeze, high above the ground are a sight for the Gods.

The dining room had three glass tiles in the roof through which sunlight slanted into the room. I have fond memories of hot afternoons when I used to enjoy fragrant, parboiled rice and rich, spicy fish curry seasoned with coconut. The meal was tasty but ‘hot’ and I used to get up from the dining table drenched in sweat! Palakkad is one of the hottest places in Kerala and the mercury used to rise above 40 degrees Celsius routinely during summer. The kitchen with its wood burning fire places was an endless source of fascination. The room was dimly lit with only two light bulbs and in those days Kerala used to suffer from chronic low voltage. The orange flickering flames used to project strange shadows on the grey walls.

Childhood was a time of wonder. We used to visit Kerala during the summer holidays. It was a long train journey and we used to pass through the burning heat of Andhra Pradesh en route. The Sun was red, the soil was red and barren and a hot wind used to blow turning the train compartment into a hot air oven! We used to reach Palakkad in the early hours of the morning and Kerala used to spread her welcoming mantle of green. My mother used to awaken me from a deep slumber and the magical land stretched on both sides as the train entered God’s own country. The monsoon used to arrive with a bang in early June. In those days the rains used to be heavier than today. There was thunder and lightning. The rain began with the crack of dawn and continued throughout the day and often during the night. The rain was heavy and accompanied by strong gusts of wind. The water dripping down from the roof used to form small puddles on the ground. I enjoyed scampering among the puddles much to the annoyance of my parents.

It was the age of wonder. I remember watching a series called ‘The Wonder Years’ on television. As I grew up, slowly the wonder started to disappear. The area also began to modernize. New large houses were built, terraced roofs began to replace tiles and the National Highway 47 was constructed passing right behind our house. The author Peter Matthiessen writes in his book ‘The Snow Leopard’ that as we grow up we begin to lose the sense of wonder with which we used to view the world when we were young. The child is one with the world around him and the sense of a separate ‘I’ has not yet formed. As we grow we retreat into defensive walls and crannies away from the grand stream of life. It is ironic that as we begin to take greater control of our life we lose our sense of wonder. We begin to resent this loss either consciously or subconsciously which is richly expressed in our art and culture. Writers, poets and painters have long grappled with it.

I am aware that my sense of wonder, of being one with the universe may never return. The sense of grief and loss is palpable. As an adult there are only brief and infrequent episodes when I can unite back with the universal Soul. These episodes are to be cherished and treasured! 

 

Author: Dr P Ravi Shankar was born in Kerala and spend his childhood and teens in the megapolis of Mumbai, India. He was educated in medicine at Kerala, and Chandigarh and in medical education at Coimbatore in South India. He has always been fascinated by nature and mountains and after his post graduation journeyed to the lakeside city of Pokhara, Nepal in the foothills of the Annapurna Himalayas where he taught at the Manipal College of Medical Sciences. He started a voluntary medical humanities (MH) module at the institution. Later he shifted to the historic city of Lalitpur in the southern part of the Kathmandu valley where he conducted a MH module, Sparshanam for all undergraduate first year medical students at KIST Medical College. In addition to MH, small group learning and medical education

Dr Shankar is keenly interested in promoting rational use of medicines and has been closely associated with the Discipline of Social and Administrative Pharmacy at the Universiti Sains Malaysia at Penang, Malaysia where he is a honorary lecturer. In 2013, Dr Shankar journeyed to the Caribbean enamored by his friends’ description of pristine white sands, azure blue seas and warm sunshine. At present he is at the Xavier University School of Medicine in Aruba, Kingdom of the Netherlands where he is a Professor of Pharmacology and Chair of the Curriculum Committee. He has been facilitating a MH module for first semester medical students at the institution since February 2013. The module is conducted in small groups and uses case scenarios, paintings, role-plays and activities to explore different aspects of MH and has been well received by students.  Email: Dr. P Ravi Shankar.

 

 

Quilted: S.A.D. Poem

This poem is also on OJCPCD and can be read as a PDF  Download Quilted

Persistent scratches ripping through the tranquility of the night,
and bedsheets dusty with flaked skin,
mingled with dried blood in the mornings.
Her skin stained with the purple sting of potassium permanganate,
burning from the relentless scorch of tea tree oil, smothered in topical corticosteroids.
Bandaged to retain moisture. Unbandaged to promote air flow.

A blur of diagnoses and “diagnoses” paraded by,
convictions by professionals and well-meaning relatives:
“No heat, no chlorine, no sunshine, no pollen. No butter, no wheat, no potato chips, no fat, no chocolate, no seafood, no meat, no sugar, no salt!”
Too much American food.  oxidized oils, pesticides, hormones-those damn Oreos, all to blame.
“This doesn’t appear to be a food allergy, but we can run some tests…”
“You see, the American doctors don’t study this. This is a question of inner body balance…”
A question of hotness and coldness of the body, toxicity, mystery, cortisone creams.
And a vicious cycle of irritation, scratching,
                                                broken skin, infection, itchiness,
                                                                                    crying, scolding, shouting, scratching…

And the mingling of voices of authority spilled over the reddened cracks in her skin
and filled her heart with guilt and inadequacy.
“You are the only one who knows your body. Only you can know what to do for yourself-”
And the bitterness of her condition was accentuated

with the bitterness of soups and broths and reductions,
darkly resplendent with Chinese medicinal herbs, kernels, stalks, and shoots.

Later, with disappointment and failures came desperation
Cycling through past attempts, various diets.  The doctors’ echoes weren’t very much help-
the relief provided through the prescribed creams and ointments was ephemeral.
Though some knowledge provided comfort - like the dreaded skin prick testing -

            her back gridded into a 5x7 rectangle and stabbed thirty-five times

to reveal her body’s weaknesses towards watermelon, shrimp, milk, Kentucky bluegrass,
            timothy hay, walnuts, chicken, turkey, sea bass, lobster, dust, mold, and cockroaches -
Her skin still burned and flared, cracked and red and dry and unforgiving, betraying her.

I’ve watched the parade of well-meaning people walking in and out of her life: smiling
 pediatricians, puzzled dermatologists, vehement relatives. No one is to blame.

I’ve watched her sneak Oreos away from the pantry, stealing bites of childhood innocence;
                        shopping for turtlenecks; being tormented by other children
                                                                                    for the ragged appearance of her skin.

Watched my father drive three hours to the only Costco that stocked unscented Keri Soothing Dry Skin Formula and return home with thirty cases of three bottles each
                                                                        (which by the way, also didn’t work).
And I’ve watched her grow up and out of her skin,
which still bears the scars and rough patches of struggles and treatments,
up and out of reticence, sensitivity, resentment, confusion, worthlessness.
Rising above the motley patchwork of voices to wholeness.

 

 

Author Note: Clara Luu was born and raised in San Jose, CA. She is currently a sophomore at Stanford University, studying Human Biology and living an exciting pre-med life. "Quilted" is drawn from a composite of household dermatological experiences from her childhood. This piece written for the "Becoming a Doctor" medical humanities seminar taught by Professor Larry Zaroff. It exemplifies the key motifs motivating Clara to pursue a career in medicine: the mutifaceted aspects of wellness, the importance of culturally sensitive medicine, the strong role of family in the healing process, and the mysteries of some medical conditions that are the catalyst for exploration, discovery, and compassion.

My Uncle Jack and Fate

Betty Z. was 21 in 1937 when she started working at her Uncle's mecial office in the Bronx.  Herein, she relates some memories.

Pelham Pkwy Station

 In 1937, when I was 21, I took a job in my uncle's office. Jack Levine was a G.P. in the Bronx. I was taking a night course to become a medical technician at the Mandl School in Manhattan and worked during the day.  The office occupied the first floor of my grandmother's house. The Pelham Parkway elevated subway station was on the corner. For more Download Betty 1937

 

Betty and the Young Doctor, Circa 1941

Betty Z. today

"Tho’ much is taken, much abides; and tho’      
We are not now that strength which in old days   
Mov’d earth and heaven, that which we are, we are:   
One equal temper of heroic hearts,   
Made weak by time and fate, but strong in will..."  Tennyson's Ulysses

Author Bio: Betty Z. lives six miles from the Pelham Parkway station.  She has had a life full of many adventures.  At 95, this is her first publication.  It’s never too late to pen one’s recollections.  We hope to receive more of her wisdom.

 

The Overachiever's Simple Guide to a Sweeter Life

"Do you know what the difference is between an overachiever and a corpse? What the former calls his résumé, the latter recognizes as an obituary.

An overachiever believes that if he or she only looks hard enough, seeks diligently enough, reflects long enough, and suffers enough, that happiness and success will eventually come. The Overachievers Simple Guide is for those of us who have come to recognize the fallacy of this belief, and wonder, what now?

"This 25 page booklet is about everything else there is in life, aside from awesomeness and achievement. It is for the overachiever who knows some really awesome people, and exactly for that reason, doesn’t want to be them. OASG is not going to tell you anything you don’t already know. It is only going to tell you what you already know but haven’t yet heard. It is not meant for the fearless daredevil, those unique individuals who don't care if they die young or old, alone or among loved ones."

O.A. Chiever, an old friend, sent me a link to his book which is now available free or for 99 cents at the Kindle Store.  He wrote: "For fun, I have put together a few short essays into a 25 page ebook, which I've self-published and is now available on Amazon for Kindle. (If you don't have one, you can always read it online, or on your ipad/iphone)." 

For those of you who are interested, it's an amazing read.  Takes ~ one hour.  Get OSGSL If you want to read it, but dont have a Kindle, iPhone or iPad, write me and I'll see if Dr. Chiever can send you a copy.

Giving Thanks for the Gift of Time

"On Thanksgiving we are grateful for all of the blessings bestowed upon us: good food, a comfortable lifestyle, family and friends.  There is one gift, however, that we may be overlooking.  It is the gift of time."  Len Hoenig, an internist in Coral Gables, Florida, "gifts" us with this short, heartfelt essay that can be considered on Thankssgiving Day.  Len, is no turkey!  See:  Download A Physician Speaks from the Heart 

A Grisly Narrative of Love

"Nobody asks [us] dragon parents for advice; we’re too scary. Our grief is primal and unwieldy and embarrassing. The certainties that most parents face are irrelevant to us, and frankly, kind of silly. Our narratives are grisly, the stakes impossibly high."  So writes, Emily Rapp in an Opinion piece about her child with Tay-Sacks disease.

Wilh all the fanfare about Tiger Moms -- Ms. Rapp's essay is an important glimpse of reality, far from the ivied halls of the Academe.

See Notes from a Dragon Mom.

Marginal Notes: What's in a name?

 
Romeo and Juliet

  What's Montague? it is nor hand, nor foot,
      Nor arm, nor face, nor any other part
      Belonging to a man. O, be some other name!
      What's in a name? that which we call a rose
      By any other name would smell as sweet.

While perusing articles on health care in the medical literature as well as in the lay press, I frequently run across the misnomer “physician's assistant.” (Reader, take note of that terminal “apostrophe s.”) What the editor really means, of course, is “physician assistant,” the designated title for the PA profession.  more»

 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."

Marginal Notes: Two Rivers, Two Towns

 

Manhattan skyline at night

That evening, after dinner, I stood on the second level of the Chart House restaurant and looked out at the city.  To the north the George Washington Bridge spanned the blackness; to the south lay the Verrazano Narrows, while directly across the water the city sat, sketched out in a thousand points of light:  clusters and strings of precious stones, like rich jewels in an Ethiop’s ear—brilliant diamonds, amber topazes, blue sapphires, red garnets.  more»

 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."