It was 24th of December, I was posted in the USG section of Tata Hospital. The next patient was a 60 year patient named Mr. Joseph. He was operated for a cancer of the oral cavity, which recurred twice in his neck and he re-operated for the same. he had now developed another swelling on the opposite side of the neck. He was here for a USG guided FNAC from the new swelling (which is like taking out a small sample for examination). This looked like another recurrence and the cytologist examined and confirmed the presence of malignant cells. By this time Mr Joseph had figured out that something wasn't right (Being operated multiple times, he was quite well versed with basic medical jargon.) He asked me "Doctor , how is the report? " I explained him that it looks like another recurrence and I called out the next patient. He went outside and came back again asking if he can have a word with me. He asked me by when will the report be available, which is usually 2-3 days. By that time Tata Hospital had adopted an online system and patient could access the reports online. Once they are online, the patient gets an SMS regarding the same. So Mr. Joseph calls me outside and tells me " Beta, can you delay the report and the SMS by a few days?" That was a strange request as most of the patients want their reports to be processed asap. He continued, "I want to enjoy Christmas and New Year with my family in a happy mood. I don't know how many of them are left with me." I had tears in my eyes. I didn't know what to say to him.

            That's when it hit me that we often do not realize what the patient goes through before he comes to us and while he awaits a report from us. As a radiologist we do not have a lot of actual interaction with patients, except for USG and intervention procedures. And that's the reason I like both of these. We used to have a lot of patients who come for yearly/ 6 monthly follow up USG to rule out any recurrence or metastasis. Imagine the anxiety each of these patients has as he boards his train for his follow -up check up, while he discusses his illness with his fellow inquisitive travelers (who always has a story about some distant relative/ friend who died of cancer or had a bad recurrence), while he waits outside the USG room for his appointment (where his fellow patients too often have scary stories), while we are doing the USG and once we are done with it. All this while he and his family are praying that he remains cancer free. Imagine yourself in that situation. It must be tough. And once he is done with it , his question is "Dactar sab, report kaisa hai?" (Doctor sir , how is the report?). I have seen my colleagues and my juniors often saying "Apke doctor ke pas jao, woh bataenge apko (Meet your doctor he will tell you the report) and that too in a rather insensitive tone. In fact even I have done that at times. This is especially true if the report has some positive findings. Communicating bad news to the patient in the appropriate way is an essential skill which a physican must develop. Due to the limited patient interaction we have, this is something that we lack and maybe that's one of the reason why we fail to convey reports to patients . For the patient however the anxiety gets even worse  as the treating physician's OPD is usually 2-3 days later. Imagine what the patient goes through for those two days. " There must be some problem, that's why the doctor didn't tell me right away", that's the first thought that comes to his mind. And he thinks of the worst possible outcomes , only for the doctor to tell him two days later that the report is perfectly normal. It would not have taken more than few seconds to let him know that report is normal. And I have seen the sense of relief when I tell them that the report is fine. That look says it all. Even when there is a positive finding , I feel it's best to tell them in simple terms what are the implications of the same as patients assume the worst possible outcomes when they are uninformed. Imagine this is just one report. There are at least 5-6 reports he has to collect every time. These are times when "Ignorance is bliss" seems so apt (in the case of uneducated patients who do not have much idea about these as compared to the informed Internet savvy educated types)


         At Tata , we get patients from all over India , it being a tertiary care center for oncology. Being the one of the top most government institute for cancer treatment, that's a place where patients get referred to from the remotest part of India. I had a patient who came all the way from Andaman and Nicobar for his follow up. He was treated case of rectal cancer. While doing his USG he told me how he had to travel for approximately 60 hrs from Andaman to Kolkata and from there a train journey for 40 hrs . And then he waited for another hour in the line before he came to me. All of this for a 5 min test (at times even less than that). And what would he feel if, at the end of these troublesome 100 odd hours he is doesn't get an answer. I told him his report was normal and he had this huge smile on his face and he thanked me and said if I ever visit Andaman , I have to come to his place.


       The story is not different at Municipal hospitals. I was in the surgical ward during my second year of residency, going through patients' files, looking for that elusive " good exam case". While going through one such files , the relative told me "Dactar sab , kya hua hai inko, char din se yeh sab davai , test ho rahe hai. Par hua kya hai inko. (Doctor what has happened to him. We are being doing all these tests and taking medicines since four days but exactly what has happened to him). It was a case of duodenal ulcer , which I explained with the limited medical knowledge I had at the that time. The relative and the patient both had a smile on their face (in spite of the pain he was going through) and told me that no one had told them till now what was the exact problem since they were admitted.


       Communicating with patients in the right way is not only important for the patients but that is also important for a radiologist. That way you assure that the patient stays with you. Also being a para-clinical branch we do not get the kind of satisfaction our surgical/ medical colleagues get once they treat the patient. Building a good rapport with the patient, talking to him is one of ensuring that. It's an important habit which we may realize once we start private practice. I remember one of my professors telling us this when we were caught postponing patients " Now you are refusing these patients, behaving rudely with them. Why ? Just because they are coming to your government hospital? Once you will leave this place you will crave to have such a number of patients and you will have to talk to them politely to each of them". Not only that but communicating with the patient will often save you time and help you from missing important findings. For e.g. One of my juniors came to with a patient saying he diagnosed situs inversus totalis (which is basically a condition when there is a left right inversion of organs) and he had some doubts in the rest of the scan. On asking the patient , this 60 year old lady ("maa-ji") pointing to her abdomen says " Beta yeh sab ulta hai . Idhar ka cheez udhar hai and udhar ka idhar. Aur yeh pitta ka thaili bhi nikala hai (Everything is opposite. The stuff on the right is on the left and vice versa. Plus she had her GB removed for stones) ". With a disappointed expression , my junior was like, " Yeh pehle nahi bata sakte the maa-ji" (Couldn't you have told me this before!). She would have definitely told him ,if he had asked her. After all Radiology (and medicine for that matter) is only as clinical as you want it to be.

      As always there are two sides to the coin. The amount of cases each doctor sees every day in any of the government hospitals is huge. But that does not give us a reason to disrespect them in any way. May be for me its easier to say all this. Being on the para-clinical/ non-clinical side we do not have to interact with many patients. My clinical colleagues handle so many patients day in and day out and we can't expect the same from them. Or in fact they may be even better than us at handling patients, communicating them their reports. But for others who aren't as good as them , the next time a patient asks you this question " "Dactar sahab , report kaisa hai? ", please spare a minute and do let him know the same in a language that he understands.

This is so true!!

P.S. Please do let me know your views in the comments.

 I had to travel to Delhi for an exam and this is a short account of the same. The title is sucks and is cliché but then couldn't come up with a better title so thats what I had to settle with. Is Delhi "dil - wali " ? I am not quite sure , but is definitely full of people who like to flaunt- money, looks, attitude. Atleast thats the Delhi I saw!

Anyways I write this article to share a few travel tips which I found in handy. So to start off , the first thing you need a smart phone with decent net connectivity as traveling in Delhi can be a bit confusing. The following apps come in handy :

1. The Quintessential Google Maps : Click here to download. 
2. Delhi Metro Rail App. Click here to download. This is a neat app which shows the metro route with connecting stations , fare, approximate travel time and the nearest metro station. Also there is a list of places to visit with the metro station closest to each which comes in handy!
3. Any of the following Taxi services , given the notoriety of the Delhi auto drivers. In fact you can use all of them one by one. Out of all the three services, I found Uber to be the most useful to get a cab immediately while Taxi for sure is good for booking cabs on a later period which is not possible using uber. Click on the name to download. Click here for free credits
• Taxi for sure  
• Uber 
• Ola

The easiest way to search for boarding is to do an online search and select a hotel/ hostel which suits your need. There are many cheap hostels which suit the needs of people whom roaming around in the city is a priority and can compromise on stay. Booking and Hostel World are good places to start off. I stayed at the International Youth Hostel Delhi which I found a decent and safe place to stay (Read more here : International Youth Hostel).

Once you arrive at the Airport/ Delhi railway station, you should get the Metro card which comes in really handy. For a refundable security deposit of Rs 50, you can get the card at any metro station and that will save you the long ticket queues. Also you get 10percent discount on all your tickets. If you are arriving at the airport (national or international) , the Airport Metro line is the cheapest and fastest way to get into the city. The ticket for New Delhi station is just 100 bucks which will take anything from 300 to 400 bucks by cab. For traveling within the city, metro is the cheapest option and from your station to your destination you can choose either the above cab services or the local autos/ cycle rickshaws.

I didnt get enough time to roam around but I did manage a few places. Out of the Red Fort , Jama Masjid (both of which are closeby) and Humayun's Tomb, I like the latter the most. If you are group of people it would be advisable to take a local guide as roaming around just looking at these monuments doesn't make much sense. The light show at the Red Fort is something you should not miss. Check out the timings here. Also a visit to the India gate in the night is a must.

I didnt interact much with people but the ones I did (mostly my cab drivers, hostel staff and a few random tourists whom I forced to clicking my pics) were helpful. The area around South Delhi is safe. I visited the India gate on Saturday at midnight and it was quite crowded with families having a fun time in the gardens parallel to the path leading to Rashtrapati Bhavan.

All in all it was a pleasant short stay!

Old Delhi - View from the Jama Masjid minaret!

Old Delhi - View from the Jama Masjid minaret!

Old Delhi - View from the Jama Masjid minaret!

Old Delhi - View from the Jama Masjid minaret!

Old Delhi - View from the Jama Masjid minaret!

Jama Masjid

Meena Bazaar

Humayum's Tomb

Humayum;s Tomb

Humayum;s Tomb

Humayum;s Tomb

Red Fort

Red Fort

P.S. It was a short trip and I didn't end up exploring much of the city and its people so its a shallow more of a technical post!

" The fear of death makes animals fight for their survival. Might becomes right as only the fit survive. With strength and cunning territories are established and pecking orders enforced. Thus, the law of the jungle comes into being. Animals have no choice but to subscribe to it. Humans, however, can choose to accept, exploit or reject this law.
Thanks to our larger brain, we can imagine and create a world where we can look beyond ourselves, include others, and make everyone feel wanted and safe. We can, if we wish to, establish a society where the mighty care for the meek, and where resources are made available to help even the unfit thrive. This is dharma.
Unfortunately, imagination can also amplify fear, and make us so territorial that we withhold resources, exploit the weak and eat even when well-fed. This is adharma. If dharma enables us to outgrow the beast in us, then adharma makes us worse than animals. If dharma takes us towards divinity, then adharma fuels the demonic.
The Kauravas are stubbornly territorial before the war. The Pandavas struggle to be generous after the war. Adharma is thus an eternal temptation, while dharma is an endless work in progress that validates our humanity."

These are words from the final chapter of the book on Mahabharata by Devdutt Pattanaik and they quite aptly sum up the essence of the book. Rather I should say that of the epic called Mahabharata. First a word about the author's contribution. He has managed to present the humongous piece of literature in a concise manner. The text is lucid and he has tried to simplify the confusing tangles of relationships. He keeps providing us short revisions everytime he reintroduces a character in subsequent chapters. And this comes in handy as remembering the lineage if each character is a pain. It's like the desi Game of Thrones. Everybody is related to everybody in some complex way and there are too many bodies there to remember. Plus there is karma which keeps coming back at intervals. So by the time it hits back at someone, you are way ahead in the story and recollecting the back story is difficult. He doesn't complicate things by showing off his vocabulary and keeps the language simple (I guess that's the only reason why Chetan Bhagat has such a following in India I guess. But I doubt whether he does that to hide his vocabulary or the lack of it). Plus that was the very reason the scriptures were written in Sanskrit so that only a small portion of the population could understand them. I don't know how accurate his version is but it's a book that can give you a gist of the story in the simplest possible way. There must be many other authentic translations but then as they say Devil is in the details. It would have been difficult for me to interpret all the plots and subplots if they were presented in a more complex manner. That's just my opinion though. He has also provided these small snippets at the end of each chapter giving us interesting facts and revising those complex subplots. Also even though it's labelled as an " illustrated retelling " , the illustrations don't serve much purpose

Coming to the more important part. The epic itself. I am otherwise an atheist and was sceptical about reading the Mahabharata. But then it's nowhere close to what I thought. It's not about gods and goddess. And to contrary to belief , it's not about the Kurukshetra war. That definitely forms an important part of the story but it's not the central theme. In fact it's a medium through which the central theme is elaborated i.e. Dharma and karma. And by dharma it never means blind faith and superstitions as projected by some of the present day " dharmik babas" . It means the righteous path, what is the ideal way of life. It's not that reading this has transformed me at a spiritual level , but does make you think about so many things. Keeping aside the spiritual part of it, it makes you aware of how awesome our forefathers were. Compiling such a huge book and carrying forward it's legacy through so many generation is a tremendous task. All this in the world without computers (They didn't have any of the cloud drive technology where they could back up their data at regular intervals. One hundred thousand verses over a span of 18 chapters). All the stories have such good morals and which are quite appropriate even in the Kaliyug. Plus their knowledge of astrology and other life sciences is fascinating. During the war there are these arrows which multiply as they travel. Some postulate that the ancient Indians were aware of nuclear weapons and this was an example of a nuclear fission reaction. I think that is a bit far fetched, but you never know. The other interesting part and the one that I liked that the actual stories are way different than what they have been presented to us. Why have always been told the story of how Kunti asked Arjuna to share Draupadi equally with his brothers but then there are other reasons to it too. Here it is :

"In her past life, Draupadi had invoked Shiva and asked for a husband who was honest, a husband who was strong, a husband who was skilled, a husband who was handsome and a husband who was knowledgeable. Shiva had said, ‘You will get all five men that you want for no single man, except God. In another past life, Draupadi was Nalayani, the wife of a Rishi called Maudgalya. He had a terrible disease that made him cough and spit all day and covered his skin with scales and rashes. Still Nalayani served him as a devoted wife. Pleased with her unstinting service, the sage offered her a boon. Nalayani requested that he use his ascetic powers to indulge all her sexual desires. Accordingly, Maudgalya took the forms of many different men, some human, some divine, all handsome, and made love to her in many different ways. After indulging in sexual pleasures for many years, Maudgalya decided it was time to renounce the world. But Nalayani was not satisfied. ‘Who will make love to me after you are gone?’ she asked. Disgusted by her insatiable lust, the Rishi cursed her that in her next life she would be the wife of many men."

There are other interesting subplots too. Like how Shakuni was not wicked de novo and why he did the things that he did. What made him limp. How each of the Pandavas had multiple wifes and children and how each of them plays some part in the battle. How Krishna twisted so many rules and used his powers to help Pandavas win the war. How The Pandavas too lost everything at the end of it. How the epic doesn't end with the war , it ends with Yudhishtira realising the true meaning of dharma. And that's what the central theme of the epic is. How each action of every character is governed by their good or bad karma. How each of the so called good characters have bad traits which we never knew. And in the end why the Pandavas in spite of being the good people end up in Naraka and the Kauravas end up in Swarga.

All in all, it's a good book and more importantly the story of Mahabharata is something which each of us should read at least once. It won't change your spiritual thinking in any way but it would definitely make you proud about the knowledge and legacy of ancient Indians.

P.S. I read books once in a while, not that frequently, so these were just my amateur thoughts about this book. There might be better books and people who read often would better be able to tell more about the quality of the writing and it's accuracy. I personally like something which I can read uninterrupted without referring to my English dictionary frequently. Suggestions are always welcome.

PPS: Watch this guy talk about ancient Indian wisdom

These are from last years:

Finally there!!!

The way down was easy as there path was dry. Had it rained it would have been slippery and that would have made things tough.

I would like to thank the YHAI group for organizing an excellent trek. The YHAI Ambernath consists of many senior trekkers who ensure safety of all the trekkers. The fees for the trek are also very very affordable. Here is the link for the website : YHAI Ambarnath HomePage. You can check the page for upcoming treks. I am not advertising them, but they are way better than the other hiking groups which charge anything in between 300 to 1000.

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