Medicine is unique!

https://www.tedmed.com/talks/show?id=528918

Great talk by Dr. Pamela Wible!

After a long day of work, a simple question like how are you, how was your day, is there anything I can help you with or a simple gesture like a warm hug, a pat on the shoulder, the touch of the hands is much more comforting and valuable than anything else. A million-dollar cannot buy one the comfort that these small things can.

Medicine is not about writing a note to submit to the insurance company for billing nor is it about saving the notes as a defense against a potential lawsuit. Medicine is not a matter of the bottom line. There is a difference between a factory and a hospital. What works for Mc Donalds and Burger King may not work for Medicine. Perhaps, its time for the insurance companies to realize that Capitation would not necessarily lead to high standards of healthcare. Instead, it can lead to multiple readmissions and closing of the hospitals. Perhaps capitation is decapitating Medicine itself and the treatments have become mere reflex actions based on algorithms instead of involving critical thinking. If the human body was as simple as machines, it would work perfectly. Fortunately, human beings are not machines, they are very complex human beings. Perhaps we need something else. Perhaps its time to bring the human touch back into the world of Medicine.
Doctors are not and should not be treated like assembly line workers for the sake of humanity. There should be some respect for the super amazing human body and its caretakes should be treated differently and somewhat uniquely.

Medicine is a very unique profession. It indeed bares all the nerves in the process of becoming a doctor. We see the full cycle of life: birth and death in a day. There was a time when the word 'death' was so scary to me that I wouldn't even allow my ears to hear it. Now I see it and don't blink.

One of the recent wellness talks revealed that doctors are the strongest personalities when they start but the system and personal or professional struggle beats them down to a level that they find ending their lives as the easiest solution.

Doctors use every single neuron in their brain for critical thinking, they use every single myocyte for running around day and night to make their patients rest comfortably on their beds, they force their eyes open for their patients to get a sound sleep. They miss their meals to make sure that their patients eat well. Doctors work very hard. After all the hard work, they don't deserve a tragedy in the end. They deserve a happy ending.

It is very hard to understand the struggle unless one is in the same profession, that's why it is even more important to share these Talks. To all those who have a spouse, a relative, a friend, a neighbor or even an acquaintance as a doctor, please be very kind to them, especially when they are post-call. Please do not forget to ask them how was their day, maybe give them that warm hug. Who knows they might just have declared someone dead.

Dr. Pamela Wible has done a beautiful job in spreading awareness. I just felt like sharing her work forward. My heart goes out to all those who have lost their lives. They deserved to live and save lives.
-Jaya Sonkar M.D., M.P.H.
9-28-18

©All rights reserved. Jaya Sonkar 2018

Let the sunrise of happiness begin!A three by three table of happenings and a step towards happiness!

A three by three table of happenings! - A step towards happiness

Act matters more than the outcome. Intent matters more than the act. And perception matters more than the intent.

Let’s take a small materialistic example,

	Positive Intention	Negative Intention	Unintended act
Positive Perception	Happy   :)	Happy :)	Happy :)
Negative Perception	Sad :(	Sad :(	Sad :(
Proportionate Percerption	Happy :)	Sad :(	Undetermined :|

Person A wanted to gift beautiful clothes that person A really liked, to persons X and Y. Person B bought beautiful clothes for two friends but those friends left, so s/he thought of giving it to person X and Y, so that the clothes could get utilized. Person C also bought the beautiful clothes for persons X and Y with an intention that that clothes are beautiful but persons X and Y will look fat in those clothes.

Person X has a very positive outlook. Person X was happy when s/he got the clothes from Person A, Person B or Person C regardless of the intent behind them. Person X thought that the clothes were very beautiful and if s/he worked out a little, s/he could fit in the clothes. If person X wouldn’t be able to reduce weight, person X would give the clothes away to someone else who would fit in those clothes. Person X would still be happy.

Person Y has a negative perception. Regardless of the intent of the gift giver, person Y thought that because the gift didn’t suit him/her, person A, B and C are all bad and they made person Y sad.

Person X who had a positive outlook doesn’t necessarily was ignorant of the intentions but person X chose to think positive. Even if person X found out the true underlying intentions, person X continued to stay happy. The example above is a very silly example. But there are big things in life that happen. Acts with much higher level of consequences can happen. Circumstances and situations are the best test to identify people who are true and who are not.Its not our job to punish them or reward them. But it is our job to learn from the experience and move a step closer to the reality. Sometimes, incidences in life help us in coming closer to reality. We should embrace such incidences as they teach us to set realistic expectations and not the desired expectations. Person X understood things and got close to reality without actually getting harmed. And person X didn’t let any act affect his/her happiness.

On the other hand, even if Person Y found out or understood the positive and negative intentions behind the act, person Y chose to base his/her feelings on the net result. Person Y is unhappy even with person with the good intentions because person Y fails to understand how could person A be so thoughtless and how could person B be such a utilitarian without being cognizant of other’s feelings. Person Y chose to move away from reality by setting unrealistic expectations and ignoring the truth.

There could be a person Z, who chose to be happy if the intent was good and feel sad if the intent was bad without worrying about the outcome. The loophole is that person Z will need to judge the intent and be judgemental. It’s said, ‘Those who understand, will not judge and those who judge will not understand.’

Person Z may sound reasonable and practical but who will be the judge for judging the judgement of person Z. How would person Z know if the judgement was real or not.

The above example is just to illustrate a small example. It doesn’t apply to unlawful acts. Criminal acts,acts of lying, or immoral acts are more complicated and beyond the scope of the current discussion. In general, unless extremely devastating conditions occur, which have another tangent, most of the happenings in life are mere acts. It’s our mind that can turn it into good or bad leading to happiness or sadness respectively. That being said, it doesn’t mean that one should turn a blind eye towards the reality. Instead, we should improve our understanding and come closer to reality.

If we are unhappy with someone, it is possible that someone is unhappy with us. While we think that our reason is legitimate, someone else might think that their reasoning is legitimate too. People who seem to be good to us can be bad to others and who seem to be bad to us can be good to others. It relative.

The gist is that our happiness depends on ourselves. The world cannot change, the people cannot change but we can change how we perceive things and learn to stay calm and happy. Life is too short. We are a tiny finite speck in the infinite timeline. Whatever seems as big as a mountain will go away with time anyway because eventually we will go away and with us all our experiences and feelings will go away. Then what is the point in carrying the big mountain with us when all it would do is make us feel burdened all the time. Why shouldn’t we remove that big virtual mountain and feel light and rise, rise above the cobweb of complexed feelings into the clear sky. Why not simplify things. Why not have a positive outlook and see the glass half full. Seeing the glass half full doesnt mean that we don’t know it is half empty. Its just about being thankful for having it half full. Why not smile and generate endorphins and stay happy and healthy! Why shouldn’t we reduce the 3 by 3 table into 1 by 1 table of positive perception and happiness.

Jaya Sonkar, M.D., M.P.H.

©All rights reserved. Jaya Sonkar 2018

A toast to a good life, because we are a long time dead!

A toast to a good life, because we are a long time dead!

Oftentimes, while discharging elderly debilitated patients to a subacute rehab, I wondered what kind of experience do patients get there. I went to the rehabilitation center today where many elderly patients were living in a nice blend of a hotel and healthcare facilities. It harbored multiple family activity rooms, physiotherapy room instead of a gym, a humongous bathroom with giant bathtub instead of a pool or a jacuzzi, a big cafeteria with diabetic, renal, cardiac, puree and clear liquid diets instead of delicacies and a dedicated smoking area. A soothing music  and fruit flavored water everywhere made the patients and visitors feel welcomed.

A very nice Geriatrician gave me a tour of the facility and introduced me to the world of Geriatrics. After a brief introduction and discussion of the real problems of old age , complexities of diseases, multi-organ failures and goals of care, I started rounding on the patients. I met Mrs. Walker, an 80 yr old pt who had a hip fracture from a fall and was recovering at the rehab center after her surgery. She looked content with the care and was waiting to get better to be able to return home. I saw several other similar patients, spoke with them and their families. Most of them were content with the care and didn't want any aggressive care. They were all a little scared too regarding whether they would be able to go home or would they worsen and return to the hospital.

When it was time to finish the rounds and go home, I walked through the passage towards the elevator when a very old frail lady on the wheelchair caught my attention as she was extending her hand towards me. I reflexly extended my hand towards her to comfort her, when she held my hand nicely and warmly and tightly and she wouldn't want to let it go. It felt very cute. It felt very cute just like it feels when a baby holds the hand. She was trying to say something, but was unable to express. She was demented and had multiple strokes in the past which had hindered her communication skills remarkably.

I don't know who she was, how she was in her young life, was she nice to people, was she mean to people. To me, at that moment, she was as pure and innocent as she could be. 

We all start our lives so pure and most of us end or will end our lives so pure. So what happens in the middle. Some people understand the meaning of life earlier, some later and some never. Some people live their lives to the fullest, live happily, some make mistakes and repent, some don't learn from their mistakes and some try to create mistakes in other's lives.

Based on the experience with terminally ill patients and very old patients who retained their mental status till the end, everyone had one thing in common. Everyone who was content , whether rich or poor, light or dark, short or tall, fat or small, they all had true love in their lives. True love could be with anyone, parent, sibling, spouse or friend or any person who gives you a deep understanding. It's a feeling of loving someone more than yourself. The love with material makes the process of dying harder. The true immaterial love makes it easier.

In our productive life, we should focus on finding and giving love and kindness. Bringing a smile on a face of someone in pain, wiping a tear from a crying face, feeding the hungry, and healing the sick gives a deep satisfaction. These good deeds become our immense treasure as we grow old.The materialistic pleasure stays here while the soul flies away on parting from the material body. Acts of kindness and love make the soul lighter and lighter. And the lighter it is, the easier it flies.

In our productive years of life, we must gather richness of kindness and love and keep our heart lighter and brighter. Ego, jealousy, power play and treachery would make the soul heavier and heavier.  We should aim not for ruling the mini kingdoms but for dissolving such mini kingdoms that create knots in the smoothness of nature. We should aim at making someone's life better and not miserable.

People who understand this earlier are able to live a better and fuller lives. Those who focus on materialistic pleasure, sadism, and power play end up miserable  in their own minds. I have seen elderly who have been miserable repenting on the bad things they did and wasted their lives. I have also seen elderly who made a very good use of their lives, learned their lessons and completed their journey feeling fulfilled that made them happy and content which in turn made their transition from the material phase to the immaterial phase very easy.

The nice old demented lady was still holding my hand. I tried to understand what she was saying. She was hungry and wanted to be taken to the cafeteria for food. She kept holding my hand as if I was her mom and she was my little girl. I assured her that we will take care of her. A nurse just walked up saying that she was going to take the patient to the cafeteria. I continued to hold her hands for a few steps towards the cafeteria while looking into her eyes and patting her back just like I do for my daughter when I drop her at the school. I then pulled out my hands from hers slowly and let her go the rest of the way with her nurse  The warm touch of her hands didn't just touch my hands, it touched something within and it gave me a very deep good gratifying sensation in my heart.

Let's try to stay as pure as we can while we have all our senses and mind and feel the depth of the gratification that results from that purity.

Let's raise a toast to a good life, because we are a long time dead! Let's raise a toast to a good soul, because it is forever living!

-Jaya Sonkar, M.D., M.P.H.

©All rights reserved. Jaya Sonkar 2018

What should one be?

What should one be?

Yesterday , Riya and I watched a movie, Ferdinand, with beautiful friends. Lovely movie and lovely message. It is very amazing how they make children's movies these days which relay a very deep message in a very simple way.

The word 'bully' probably came from the animal 'bull'. The bulls in the movie were worried that if they would not fight like a bull, they would be destined to a chop house. Little did they know, that even if they do, they would still end up similarly and get killed by others as a show of bravery. So what should one aim to be?

If we think about being a lion, the king of the jungle, how many friends does he have? He is able to maintain his pride only till he has the power. 

If one is a tiger, he may end up serving as a challenge to the hunters and be hunted down or pitied and protected as endangered by nature and animal lovers.

If one is a wolf or a fox, he has a pack. But the other packs will always be a threat. If there would be a winner, there would also always be a loser who would have lost a lot.

Lets see the soft ones:

If one is an elephant, he could be easily taken for a ride. 

If one is a cow, she will be milked and then may be a "ginormous beeferoni".

So what should one be?

Should we be ourselves, the humans, and be proud of our sharp minds who managed to divide the earth into nations, divided the population into religions and divided the resources unequally among the rich and the poor.

How about being a dolphin and splash around in the water with friends and lighten up the world with mirth and joy. Or may be a seagull and soar on the winds up high in the sky and span the world without boundaries and watch the sunrise and the sunset on the ocean everyday and live the life its own way.

Dear lions and tigers, if you see a seagull , don't roar to scare her as she won't get scared. 

Dear wolves, if you find a seagull near water, let her get her nutrition because she will do it anyways. 

Dear foxes, do not try to trick her, because she will not fall in traps.

Dear humans, please don't hit the seagull with your arrow because even if she falls, she would still fly away and you may never find her. 

Dear elephants, if you find a seagull, she would be a great companion as she would probably fly by your side and never take you for a ride.

Dear dolphins, you both would have a lot in common and would make great friends, one soaring in the sky and one diving in the seas.

Let's soar in the air

Let's dive in the sea

Let's be light as a hair

Yet be strong as a tree

Let's climb up the mountains

Let's glide from the cliff

Let's run on the plains

Let's float on the stream

Let's spread some love

And get some love

Power has an end

Love is immortal

Let's live carefree

And not be leashed

Let's live a dream

And find some peace

The 'real' real world is beautiful,

Yes, its true, I'm sure!

You just have to believe in yourself 

And be ready to explore!

Jaya Sonkar, M.D., M.P.H.

©All rights reserved. Jaya Sonkar 2018

The Apple Doctor!

The Apple Doctor

Just last night the apple of my eyes was so vibrant, full of colors and energy. We had so many plans to read, shop, explore and more upon waking up. Next morning, when we woke up and sat down to start the day, Apple won't wake up. Shocked, I cried, "Wake up! Wake up!. This calls for emergency. I ran to the doctor's office. My Apple was dying but I was told that they ran out of empty slots for walk-ins. I will need an appointment. There were no emergency treatments available. When I insisted, they saw Apple. They told me that Apple was sleeping and there might be little hope for survival. It was best to let the time take its course. They gave me an appointment in 2 days.

Tired from work , I returned and ran to the doctor's office. They told me that Apple needed to get admitted. Apple needed special care. One of the specialists evaluated and suggested a special ward and very expensive treatment with little hope for recovery and risk of loss of memory. The last resort was transplantation which was dependent on availability and it required a long wait.

I needed time to decide! I was thinking on so many tangents. Could I let my Apple go and rest in peace, thus valuing quality over quantity of life. Or should I listen to my emotions and prolong the suffering. I requested them for some more time. In the meanwhile , they maintained Apple on life support and ensured nutrition.

 I still remember the day when I first saw my Apple. The perfect body, the soothing complexion, the mesmerizing sound, vibrant with colors. I saw and chose so many others in the past, who were good looking, intelligent, stronger memory, multi taskers, great achievers and not as demanding. But it was time to go with the shallow side of my heart for once. I loved Apple for 3 reasons, looks, looks and looks! Yes, for once I chose beauty over brains. 

It was such a difficult decision. I didn't want to lose my trophy Apple. I took much longer. The doctor's office tried to contact me a few times while I was away. I couldn't get a chance to give them my decision. In the meanwhile, I found a new special someone whose Yoga style caught my eyes and I fell in love with my new Yoga hunk. I hate to say but Mr Yogi made me forget the apple of my eyes except a few times when Mr. Yogi didn't perform well! Not to mention, the bigger behind!!

Suddenly, one day, to my surprise, the doctor's office called me and said that they were able to find the organ and transplanted the same and now my Apple is alive and energetic as before. How kind of the doctors! They took the decision for me while I was away. I couldn't wait to see my Apple again. But wait! What will I tell Mr. Yogi and what will I tell my daughter Riya, who became so fond of Mr. Yogi? 

My work kept me from picking Apple and I had to wait for a couple of days which also gave me a little more time to choose. Finally, the doctor's office called me and said that I will have to pick Apple soon, otherwise they will have to start the abandonment process. 

I ran to the office and saw a huge line. The staff members asked all the walk-ins to line up. I felt bad for the walk-ins as some of them were going through a similar experience. Having learnt my lesson, I always book an appointment. Thankfully, for pickups, you could still walk-in. I was asked about my reason or the visit and was called in. Someone from the line said ,"But, we are here in the line." The staff member told them with an attitude, 'That's because, you're a walk-in. Wait here until we find an appointment for you." I felt sad for that person but could do nothing. I could empathize with the people who were in the ginormous line, but part of me was mean enough to think, 'What were they thinking? We always need appointments.'

Fortunately, I went in and was waiting to see my Apple alive. How little did I realize that my Apple could not be taken care of by Charity care. I realised how much not having an insurance would cost me. I had to pay a fortune to get my Apple back.  For once , I thought of letting my Apple go, who perhaps may find a better someone who is much more affluent. And maybe, it was time for me to start valuing my inner voice. Acts are better than looks. As in the past, I should value brains over beauty. 

After a few minutes, I thought, 'Good lord! Apple knows all my passwords, articles, research papers and more. Moreover, Apple 12 inches macbook is really dashing and the retina display is amazing. Memory may not be good but performance and speed are awesome!!! ;) Forget about brains! Let beauty win. However, I won't forget my Lenovo Yoga either. It has a sleek design and perks of its own. Love changing it back and forth to tablet and desktop mode. And its less than half the price!!!

My good side," However, I promise, my next love will be brains again, like it always did in the past... Androids and Windows, you will always be my first and last love. Just forgive me this one time."

My evil side, " We'll see when the time comes. Even Vishwamitra was fooled by Menaka!" 

And the inner battle continues!

Hey! I have one more thing to say before you go!

"I am so glad that people were equally frustrated at the Apple Store as much as they are at their Doctor's Office!!! We are not the only bad ones out there. LOL! "

Jaya Sonkar M.D., M.P.H.

©All rights reserved. Jaya Sonkar 2018

My Heart is Beating!

My heart is beating!!!

Me: Hi Mr. Jackson,  how are you feeling?

Mr. Jackson: I am fine. ( In a feeble voice)

Mr. Jackson was waiting in the holding for his CABG ( Coronary artery bypass graft).

He was very anxious and scared but was facing it like a brave heart. 

 (One of the perks of rotating with Anesthesiology is while I get to learn about wonderful anesthetics and life saving ventilation techniques, I also get to watch the great surgeries which is often not feasible with other rotations.)

Speaking of Braveheart, I recently watched the sacrifice scene from the movie Apocalypto, during my recent visit to the historical places like Uxmal, Chichinitza, Tulum and many more in Mexico. I felt so queasy after watching the butcher cut through the victim's chest , pull out the heart and squeeze it, followed by many more cruel acts.

Learning about the ancient Mayan history and human sacrifices over and over again from every guide at every tourist spot was making me sick to my stomach and I was unable to enjoy the scenes, because my over imaginative mind was visualizing the scenes, as they were being described.

Surprisingly, when I saw Mr. Jackson's chest being cut open, his heart being emptied into the machines and then paralysed, it didn't bother me at all. I kept watching the whole surgery in awe, without any hesitation. I knew that the expert surgeon with amazing finesse in his hands, a real Braveheart, was saving Mr. Jackson's life. Indeed, in my eyes, the surgeon was the superhero.

It was the similar beating heart, similar goriness but one was taking a life and the other was giving a life. Both the butcher ( a villain in my eyes) and the Braveheart surgeon ( a superhero in my eyes) were courageous enough to cut open someone's chest but one was ruthless and the other was very careful and protective.

The same courage and power  which could take someone's life,  when positive could prolong someone's life.

I feel so thankful to be born in an era where morals and ethics are so much valued. Where strong and powerful people assure safety of the individuals. It's a pity that we still have some people who like terrorizing other people. The recent blast at the Port Authority was very disturbing, moreso because my spouse gets off at Port authority everyday around that time for his office commute. Thankfully, when the blast happened, we were in Mexico for vacation. However, even the thoughts give me goosebumps.

History is very important. Especially when it is a sad one. So that, we can make sure , it never gets repeated. So that, we can understand the pain associated with the destruction caused by wars, nuclear attacks, massacre, bomb blast, air crashes or unpleasant rituals and can make sure that it never gets repeated.

I wish that the kindness could be instilled in to every beating heart. Empathy and love could be transfused into everyone's veins. And, perspective could be implanted in everyone's body.

It would be so wonderful if every heart that beats, beats for beating the cruelty and inculcating love.

My heart is beating!!! 

Jaya Sonkar

©All rights reserved. Jaya Sonkar 2017

Everything has a purpose!

Everything has a purpose! 

'This Thanksgiving, I want to take the time to thank all my friends, family and mentors, who served a great purpose in bringing me to where I am.'

If I wasn't born, I wouldn't know how beautiful life could be
If I didn't see deaths, I wouldn't find a deeper meaning of life

If I wasn't a patient, I wouldn't know what pain would mean
If I wasn't a doctor, I wouldn't know how fulfilling , healing others could be

If I wasn't rushed, I wouldn't know how relaxing, sitting in the sun and having a drink could be.
If I was never idle, I wouldn't know how accomplishing , tough work could feel.

If I didn't make a mistake, I wouldn't know how to fix it
If I didn't do things right, I wouldn't know how gratifying it could be.

If I wasn't a child to my loving parents, I wouldn't know what pure fun means
If I wasn't a mother to my beloved daughter, I wouldn't know what pure love means

If I didn't have my beautiful sister, who held my hands and was always kind
I wouldn't be so calm and reassured that she would be my spine, if I ever break mine.

If I didn't have an adventurous spouse, I wouldn't have explored the adventures.
If it weren't for his dedicated efforts, I wouldn't have enjoyed the tea on the tree house with birds.

If I didn't fall in the muddy puddle, from that bike, with my childhood friend 
We wouldn't have so much to laugh about, everytime we chatted

If I didn't have a failure, I wouldn't know what would success mean
If I didn't get success, the power of optimism and diligence would have gone unseen

If I didn't have that friend, who gave me courage and made me feel empowered
I wouldn't know how great a deed of uplifting others could be

If I didn't have the kind mentors and guides, who backed and encouraged me,
I wouldn't have understood how fulfilling teaching others could be.

If I didn't have those lovely friends and helpful neighbors,
I wouldn't be able to feel at home in a foreign land.

If I didn't get the kindness from others,
 how would have I paid it forward ...

If I didn't have that colleague, whose ego kept him blinded from reality 
I wouldn't know how wise the phrase, 'picking your battles' and 'letting go' could be

If I didn't have those wonderful colleagues, who backed me up in tough times,
I wouldn't know how wonderful having true supporters could be

If the clouds weren't there,
How would we miss the sunshine

If the sun didn't shine too bright,
How would we miss the rains

If the rains werent there,
How would we see a rainbow

If the winters were not there,
How would we see the snow

And if it wasn't for this Thanksgiving,  how  would I find a right time

To thank everyone who helped me brighten up my life.

A big thanks to all my near and dear ones!

- Jaya Sonkar

Post script:

As a child , I was made to say this prayer that is quoted below , everyday. I understand it's depth now.

"Thank you God for world so sweet
Thank you God for food we eat
Thank you God for birds that sing
Thank you God for everything."

Amen!

©All rights reserved. Jaya Sonkar 2017