Tag Archives: Military Hospital Ambala

DEFINING INDIAN IDENTITY – LISTEN TO THE HEART

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Ambaa Shambhavi Chandramouli Rabalaaparnaa Umaa Parvati,         

Kali Hemavati Shivaa Trinayani Katyani Bhairavi         

Savitri nava yauvanaa Shubhakari Samrajya Lakshmipradaa,         

Chidrupee Para Devataa Bhagavati Sree Raja Rajeswari.         

 The opportunity to serve in the Indian Armed Forces works like a powerful magnet.It draws into its folds the youth of the country from a multitude of villages that dot our landscape.My service in uniform gave me the wonderful opportunity to personally know and get acquainted with a broad spectrum of Indian population.The Indian Identity that I would describe is the product of such direct and first hand experience of the people of my land.         

After a brief and exciting period of basic military training in the historical city of Lucknow,in the State of Uttar Pradesh,my tour of duty took me to the city of Ambala Cantonment in the State of Haryana.The name Ambala is very dear to my heart.Traditionally,Indians would not desire to fight the evil and dark forces.They would rather prefer to rely upon the names of the mighty Lords that they worship.It is Shiva,Vishnu,Rama and Krishna who would fight the battle on their behalf and Indians could simply sit back and relax and watch the demons getting vanquished.But when a physical fight becomes inevitable and when pushed to confront an enemy and to take up the challenge personally,Indians derive their strength and they get infused with courage by remembering with adoration the name of BHAVANI,also known as DURGA,AMBA,KALI or simply referred to as MATA(MOTHER).That name is used as the battle cry.That name is the armour of divine protection they prefer to use on the front lines of war fields.When the confrontation is real,nothing works better than the sweet name of AMBA.Hence Ambala has represented to me the willingness and the determination of Indians to fight the battle against the enemy.On my second tour of duty in Ambala,I could proudly wear the emblem of Black Elephant on my left arm.Black Elephant is an elite fighting force and the military station of Ambala is its home.         

I arrived in Ambala during 1970 and had reported to the Military Hospital on my very first posting.My first assignment in the Hospital was that of an internship in the surgical division.The senior surgical specialist at that time was Major Mohan Pal Dhir.The advice he had given me was that I should get acquainted with the patients and should try to know them as if they were my personal friends.I was given the charge of two surgical wards.My first priority was not learning the principles of surgery and the technique of surgical procedures.As an Officer-in-Charge of the ward,my first duty was to learn and remember the rank,name and regimental affiliation of each patient.It sounded pretty easy but in practical terms it was really difficult.The working hours were totally consumed with processing the medical information and preparing patients for surgical evaluation and procedures.My office staff would meticulously document all the personal information and there was no time to read that again.The patient interrogation is primarily intended to obtain the relevant medical information about their physical ailments and documenting the medical case history.It was easy to remember the medical information rather than their personal details.Since I had grown up in India,I had accepted the advice of my senior with some earnestness.The only way I could find time to know personally all the men in my wards was by returning to the Hospital and spend my evening hours conducting personal interviews with each one of them.We had a variety of sports and recreational facilities and a very lovely Officers’ Club right in front of our Hospital.But I had to ignore such perks of my Service.Thus my journey in uniform had included a commitment to know the men at a personal level.         

A SIMPLE EXPERIMENT TO KNOW THE HEART :         

Soon after I had assumed the charge of the surgical wards,during one of my evening visits,my office staff had reported that one of the patients had lost his expensive wrist watch.While taking a shower,the patient had removed the watch and forgot to recover it.Within a short time,the watch had disappeared.It was apparent that the watch got stolen by some other patient.I could have simply notified the Military Police and asked them to investigate the incident.Or,I could have used my authority and could have ordered that all patients should be confined to their beds and directed the staff to conduct a thorough search of their personal belongings.But I lack the temperament of a law enforcement official.I depend upon my ability to observe things and derive answers from such observations.What I had observed was the fact that in India,people share a common concern about truth.Truth or reality can not be concealed.Whatever a person may do,in the person’s heart,the truth is always known.If you would listen to the person’s heart,the truth could be revealed.I had announced to my staff that I would like to listen to the heart beat of each of my patient and ascertain the truth for myself.They assembled and lined up all patients in front of my office and they marched in one after the other.I conducted this little experiment in absolute silence.No questions were asked.I carefully listened to their heart beats.After having done so,I had demanded that the watch should be returned to the place from where it was picked up and if not , the truth would only bring humiliation to the culprit.The purpose of the experiment was not to directly identify the culprit but it intended to give him a chance to search his own heart and reveal the truth.Next day,when I came to work,my staff had cheerfully reported that the watch had reappeared in the bath room and was returned to the owner.         

INDIA-THE LAND OF SATYA AND DHARMA :         

India is the land where people’s psyche has a deeply embedded concern about SATYA(TRUTH).It is a fundamental belief of all of its people.They believe that TRUTH is GOD and they would define that GOD is TRUTH.The powerful effects of TIME would dissolve and destroy all things that are unreal and in the end only TRUTH will remain and TRUTH would prevail.On our National Emblem, the Motto of the Nation is described as ” SATYA MEVA JAYATE ”(TRUTH alone would triumph).Indians cherish the value of Truth and would prefer to merge into that unchanging,ETERNAL REALITY.Nothing else would save them from certain destruction.DHARMA or Right Conduct in its simplest context would mean to Indians that they should fulfil the promise they had given.They are afraid of the consequences of a false utterance.The Story of RAMAYANA touches the hearts of Indians.It is no surprise that RAMA is their beloved Hero.He represents the values that Indians cherish to possess.The nobility of Rama lies in the fact that He had chosen to obey His father with a sincere desire that the father should fulfil the promise he had given to his wife and help him to uphold the enduring principle of adherence to Truth.              

 
 
 

   

  

LORD RAMA - A BELOVED HERO - UPHOLDER OF SATYA & DHARMA

It is no surprise that Rama is a beloved Hero. He upheld the values that most Indians value and cherish.

 

Indians carry their identity in their hearts.The identity is simply revealed by listening to their hearts.When you listen,you would know that all of them share a concern that TRUTH alone would prevail at the end of the day. As a member of medical profession, I can observe man in good health, in sickness and disease, and eventually in his death and dissolution. I also observe man’s reaction to his own condition and state of existence. I observe the physical, mental, and psychological aspects of the man’s condition. My experiment which had involved listening to the heart beats of my patients in the Surgical Ward was not intended as a ‘Lie Detector Test’. A typical Lie Detector Test describes a ‘Polygraph’ used on persons suspected of lying; it records certain bodily changes which are assumed to occur when the subject lies in answering questions. The objective of my experiment was not that of finding any bodily response or change in heart beat in response to any question. I was not trying to discover a lying person. The person who had stolen the watch knows the truth, the fact that he had stolen. Through my experiment I had tried to evoke an emotional reaction from that person. That subject had emotionally reacted to my experiment in the manner that I had expected. He had admitted the truth by simply returning the watch and I had not questioned him directly or indirectly if he had taken the watch. I did not find the lying person, but I have proved that the man had an actual psychological concern about truth.  Medicine cannot stop death and Truth cannot be delivered as a prescription. I had observed some of the funeral processions in India. People either chant “Ram naam Satya hai” ( The name Rama is eternal Truth ), or the “Hare Rama Mantra”. Man whose physical body experiences death and dissolution could not be true. If man is mortal, Indian mind seeks comfort from an idea that is not subject to mortality.        

Dr.R.Rudra Narasimham,                                                                                                                                                                                                                                

Kurnool Medical College, Kurnool, A.P.,  India.,      

M.B.B.S., Class of  April, 1970.      

          

 
 

          

 

         

 

        

 

       

 

      

 

     

 

    

 

   

  

 
 

         

 

        

  

       

 

      

  

     

 

    

  

   

 

  

  

A CHALLENGE TO EXISTENCE – A STORY FROM MILITARY HOSPITAL AMBALA

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Countries with reported cases of Tetanus

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Tetanus - pathogen

The spores of Tetanus bacilli can live in soil for years. The spores can survive autoclaving instruments at 121 degrees centigrade.

 

Clostridium.tetani - The Tetanus causing bacilli.

The tetanus bacilli live in the guts of humans, cattle, and other animals.

 

Clostridium tetani

The Tetanus causing bacilli produce deadly Neurotoxin. How would you manage this case of Tetanus if you know that the bacilli are lodged in the endometrial lining of this young woman? In 1971, we had no Human Immunoglobulin. Anti Tetanus Serum is not very effective. What are your options?How would you get rid of the bacilli?

 

Clostridia and Tetanus

Clostridium.tetani bacilli cause Tetanus.This young woman reported to the Hospital very early and her condition was diagnosed promptly.If you had known that the bacilli are lodged in the endometrial lining of her uterus, would you attempt surgical debridement? Would you attempt Curettage to remove the source of neurotoxin production?What are the risks of surgical debridement? Would you recommend Hysterectomy to save her life?Conservative Treatment did not save her life. Is there a chance that she would have been living after emergency Hysterectomy?

 

Tetanus disease first manifests in the facial muscles.

Tetanus disease first manifests in the facial muscles.

 

The jaw muscles are typically involved in Tetanus.

The jaw muscles are typically involved in Tetanus.

 

Tetanus neurotoxin affects the neuro-muscular junction.

Tetanus neurotoxin affects the neuro-muscular junction.

 

Clostridium.botulinum causes Botulism, a paralysis of muscles.

Clostridium.botulinum causes Botulism, a paralysis of muscles.

 

A STORY FROM MILITARY HOSPITAL  AMBALA, HARYANA STATE, INDIA  :    

I had served at the Military Hospital, Ambala from July 1970, to September 1971. I had served in the rank of Lieutenant during the period of my twelve months Hospital Internship Training. I had narrated an earlier experience at the same Military Hospital in my blog post titled ‘Defining Indian Identity-Listen to the Heart’. I want to recount some of my experiences to understand the nature of human condition and the challenges to human existence. The challenges are many and they are so vastly different. I am choosing to narrate the stories of those individuals whose life was cut short while they had no other health issues that could undermine their ability to live. Padma Sundarji, Lt.Col.D’ Souza, and the athlete at Army Ordnance Corps Centre, Secunderabad fought to defend their existence from the threats of Cancer. I had earlier described the nature of the Immune System that defends the human body from Cancer, infections, and foreign proteins. This is the story about a very young woman whose life was shortened in tragic circumstances and I want to stress the importance; the medical profession has a duty to avoid costly mistakes while delivering routine care.    

When people walk into a government-run clinic or hospital, the usual impression is that a doctor would listen to the complaints in about a few minutes time, make a very quick evaluation, and send the patient away with a prescription. I had mentioned that in the Armed Forces, the Medical Officers would love to spend time medically examining people who have no apparent sickness as they lay emphasis upon diagnosing a person’s Good Health. I was introduced to aspects of Medical Practice in Army at Military Hospital, Ambala where I learned that writing a prescription should not be our first concern. Major. Mohan Pal Dhir, AMC, the Senior Surgical Specialist of the Hospital at that time of my service, had asked me to converse with my patients and try to know each one as an individual; as a person and not as a diseased entity. In India, we would still follow the cultural norms and do not intrude into personal lives unless the patient desires to discuss all the aspects of their medical history.    

During 1971, I was in the Hospital Medical Inspection Room around 8.30 P.M. while my friend Lt. Mohan Lal Dubey, AMC was the Orderly Medical Officer;(Dr. M L Dubey is presently Professor, Department of Parasitology, Postgraduate Institute of Medical Education & Research, Chandigarh,India). A young woman about 17 years old accompanied by her father had walked into the Clinic. Her father had earlier served in the Indian Army. They were traveling in a bus and she was feeling unwell, and they had decided to discontinue their journey. The Military Hospital, Ambala is at a short distance from the Grand Trunk Road and the father knew the Hospital and thought that it would be better to have his daughter checked up before getting back to their village. She could not contribute any further information and did not suffer from any serious illness in her life. As she walked into the Clinic, I had noticed an expression of fear on her face, and it had alerted me that there would be some underlying problem. Surprisingly, we could not detect any reason( a medical condition ) to explain her feeling of being unwell. Her temperature, pulse, respiration, heart, lungs, and abdomen were all within normal expected limits. I did not want to suggest to this young woman that she was alright. I had kept talking to her and her father to arrive at some clues about this sudden sickness that she had experienced. While speaking to her and intently looking at her face, I had noticed with a sense of alarm, that her jaw muscle known as ‘masseters’ appeared to be a lit more ‘taut’. Masseters are the primary chewing muscles. They cover the sides of the jaw just behind the cheeks. These muscles help us to clench our jaws and to grind our teeth. The stiffening of these muscles forced me to think of the possibility of Tetanus infection. Her medical history did not reveal any possibility of contacting this terrifying disease. She had no injuries of any kind. Myself and my friend Dubey, checked her again and could not find any evidence of even a minor injury. Her throat, her teeth were normal. She was not hysterical. She was not exposed to drugs or poisons. She had no concerns or experiencing any difficulty about opening her mouth. There was no stiffness of the muscles that she could experience on her own. This stiffness of jaw muscles, this involvement of facial muscles is the basis for diagnosing the disease of Tetanus. We do not need any laboratory investigations. We need not see the Tetanus bacilli to clinically diagnose this condition. The bacilli live in the intestines of humans, cattle, horses, cats, and dogs without causing any disease. The spores of the Tetanus bacilli are widely distributed in nature, especially in top soil. The spores are very resistant to heat, and chemicals like lysol and can survive for years in the dust. But, the infection is caused only when the spores enter the body through any wound, particularly like a thorn prick, or a puncture wound caused by a nail, a splinter, or an agricultural implement. The bacilli are strict anaerobes, meaning that they cannot thrive in areas receiving free oxygen. The Tetanus bacilli germinate from its spores only where there is reduced oxygen supply. Generally, a patient would be having a dirty wound or injury. The disease manifests itself very quickly in about 2 days to 2 weeks after the spores germinated in the body tissues. The stiffness of the jaw muscles is called ‘Lock Jaw’ or ‘Trismus’. We could not conclude that she was a case of Tetanus. The sign of ‘Trismus’ was hanging in the air like a ‘SWORD’. We made a decision to admit her to the Family Ward with the Provisional Diagnosis of ? TRISMUS and initiated the prophylactic treatment against Tetanus as recommended in the Standard Text Books of Surgery. During 1970s, Indian Army Hospitals had no Tetanus Human Immunoglobulin, the antitoxin that is used in the United States to neutralize the neurotoxin produced by tetanus bacilli. We were then using Tetanus Anti-Serum that is procured from horses. This Serum could cause some serious side-effects, and very high doses are not recommended unless treating established Tetanus. She was given an initial dose of 5,000 International Units with due precautions. In India during 1970s, and prior to it, the children were not routinely immunized by ‘triple vaccine’ which is very effective against Tetanus infection. As a precaution, she was also started on Penicillin antibiotic and initiated immunization against tetanus with a dose of Tetanus Toxoid injection. I went away hoping that the stiffness of jaw muscles that I had discovered on my examination would go away and that she would be alright. Next day, when I had arrived at the Hospital at about 7.00 A.M., I came to know that the suspicion of Tetanus became stronger and the patient was transferred to the Intensive Care Room at the Acute Surgical Ward. They had treated her very vigorously and she had survived this terrifying ordeal of Tetanus for five days and had lost her battle. She had received medical attention as soon as she had become ill, and yet could not be saved. We had failed because we could not discover the seat of her infection. The tetanus bacilli after entering human body do not circulate in the blood. They remain stationary at a place where they thrive. The bacilli do not directly harm the body. It is the ‘tetanospasmin’, the neurotoxin that they excrete which circulates in the blood and reaches the neuron cells of the spinal cord that inflicts the damage. It is one of the deadliest poisons known. The poison is like the poison known as ‘STRYCHNINE’ which is used to kill rats. The poison specifically acts on the synthesis and release of ‘Acetylcholine’, a chemical that has a key role in the transmission of nerve impulses throughout the body. The stimulation, the accumulation of ‘acetylcholine’ results in rigidity of muscle groups of different voluntary muscles.This toxic rigidity of muscles gradually involves face, head, neck, trunk, extremities and the muscles of respiration. This rigidity of the body is punctuated by sudden tonic spasms, and convulsions. The patient would be exhausted and dies due to respiratory failure. Patients are nursed in dark, very quiet rooms, and are not disturbed and moved without reason. If the seat of infection is known, surgery is performed to completely clean the wound and remove all dead tissue where the Tetanus bacilli multiply. In this young woman, we could not detect the seat of infection while she was treated. After her death, the Hospital conducted an autopsy to discover the problem. The Hospital Pathologist, Major B K Sharma, AMC had later informed me that he had isolated the Clostridium.tetani bacilli from the lining of her uterus or womb. She had acquired a ‘Surgical Infection’ after undergoing a simple gynaecological surgical procedure commonly known as ‘CURETTAGE’ in which the lining membrane of the uterus is gently scraped and removed. The father and the patient did not reveal this information. A sense of modesty and Cultural sensitivity could have prevented them. The operation was done in a Clinic or Hospital and we could not obtain any details. The surgical instrument that was used in this procedure was contaminated with dust that had the Tetanus spores. The spores cannot be killed by autoclave or sterilizing the instruments at 121 degrees centigrade temperature. This apparently healthy young woman might have experienced a relatively harmless disorder of her menstrual function which would not truly require a surgical treatment. But, we have no treatment for a disease called ‘GREED’. A medical practitioner sometimes performs a surgical procedure to justify charging a patient a large amount in fees to fill up his/her pockets. In the autopsy examination, we could not find any reason as to why she was subjected to this Surgical Intervention which introduced this deadly infection into her body. She had no other complications from this surgical operation and she had no gynaecological problems and our careful examination did not indicate any problem. As a rule, doctors do not carry out a gynaecological pelvic examination in young patients and particularly when they are not married and have no symptoms and signs of a gynaecological disease. Even if we had known, we could not have done more to save her life. She was not evaluated by the Gynaecologist at the Military Hospital, Ambala. I would not think that a Gynaecologist would have done the operation of ‘CURETTAGE’ for a second time to get rid of Tetanus bacilli from the endometrial lining of her uterus. It could pose risks of its own. An emergency hysterectomy could be life saving as it would have eliminated the source of neurotoxin production and would have given us a chance to fully neutralize the circulating neurotoxin. Tragically, she got caught up in a situation with no further escape.    

BHAJA GOVINDAM – PART IV  :    

We exist at the mercy of our LORD. It is not always easy to defend human existence. This tiny bacillus needs no oxygen for its survival. The antibiotics that we may use may not even reach it in enough concentration. The bacillus has a cell wall coated with sugar molecules which may even prevent the antibiotic from entering the cell. A person even with exceptionally strong and well-developed muscles cannot defend himself from this poison. Only timely immunization is the best way to protect a person. During 1970, a spent a month at the Kurnool General Hospital, Kurnool doing my Internship in Medical Ward III. As an Intern at the Medical Ward, I did a neurological examination of a young male patient with well-built body. He was admitted for Spasticity of his muscles of his limbs, and the trunk. He was rigid like a board but had not experienced any muscle spasms or convulsions. I had diagnosed him as a case of Tetanus and had him transferred to the Infectious Diseases Ward as per the Hospital Policy. These were the two instances when I had made the Clinical Diagnosis of Tetanus and they are important and live in my memory and constantly remind me to seek the protection which only the LORD could provide.    

Bhaja Govindam, Bhaja Govindam,    

Govindam Bhaja muudhamatey,    

Sampraapte Sannihitey Kaaley,    

Nahi, Nahi Rakshati, Du krun karaney.    

Dr. R. Rudra Narasimham,   

Kurnool Medical College, Kurnool, A.P., India.,   

M.B.B.S., Class of April, 1970.   

THE FREEDOM FROM SICKNESS-SARVE SANTU NIRAMAYA

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THE FLAG OF INDIAN ARMY MEDICAL CORPS: DULL CHERRY WAS THE COLOR OF THE ROYAL ARMY MEDICAL CORPS.SIGNIFIES POSITIVE HEALTH AND FREEDOM FROM SICKNESS. BLACK WAS THE COLOR OF INDIAN HOSPITAL CORPS. SYMBOLIC OF BIRTH AND DEATH. OLD GOLD WAS THE COLOR OF INDIAN MEDICAL SERVICES WHICH EXISTED BEFORE 1943. IT IS THE SYMBOL OF SUN GOD AESCULAPIUS, THE GOD OF MEDICINE. ARMY MEDICAL CORPS CAME INTO EXISTENCE ON JANUARY 26, 1950.

SARVE SANTU NIRAMAYA :

The motto of Indian Army Medical Corps is “SARVE SANTU NIRAMAYA”. This is an idea expressed in ‘UPANISHADS’. The hymn appears as a benediction to invoke “PEACE” and hence is known as a ‘Shanti Mantra‘. It reads as follows:

OM, Sarve Bhavantu Sukhinah,

Sarve Santu Niraamayaah,

Sarve Bhadraani Pashyantu,

Maa kaschidh duhkhbhaag Bhavet.

May everybody be blessed with happiness,

May everybody live in perfect health free from sickness,

May everybody be assured of well-being(lead a life that is safe and secure),

May there be no mental thought that could arouse sorrow or grief.

POSITIVE HEALTH AND COMPREHENSIVE HEALTH CARE :

The ideas of freedom from misery and sorrow, and the state of happiness are clearly associated with freedom from sickness and complete well-being of an individual. Health is defined as ‘the state of complete physical, mental, and social well-being, and not merely the absence of disease’. The health care program must embrace all the three aspects of a disease; the preventive, the curative, and the restorative care of an individual.These three aspects of physical, mental, and social well-being are interrelated, interdependent and contiguous. The medical care should be ‘patient centered’ rather than being ‘disease centered’. Comprehensive Health Care can be described as the health promotive, health preservative, preventive, curative, and restorative health care of all individuals, at all stages of life from conception to the grave, and in all spheres of life such as home, school, work place and in the community. In the Armed Forces, the medical practitioner gives attention to any condition considered responsible for deterioration in health or likely to affect adversely the health, morale, and welfare of the personnel under his medical care. The Medical Officer in the Armed Forces not only promotes, preserves and protects the health, but also he periodically carries out an assessment of the environmental, living and working conditions of the personnel under his medical care. The threats to human health and well-being come from several directions and tragically very healthy individuals may sometimes succumb to sickness and the causative factors of several diseases still remain a mystery. Cancer is one such disease which poses a challenge to our motto of achieving ‘freedom from sickness’.

ONCOLOGY – THE STUDY OF NEOPLASMS :

The word ‘Oncology’ is derived from the Greek word of mass which denotes a swelling or a new growth. A new growth or neoplasm could be ‘benign’ or ‘malignant’. The ‘benign’ growths are relatively harmless and they may not invade other tissues of the body but can contribute to some functional impairment. The ‘malignant’ growths are dangerous to life as they tend to invade other tissues and spread to other distant sites in the body. Apart from this ‘invasiveness’, the malignant cells display uncontrolled growth and could cause a very rapid deterioration in the state of health of a victim. The term ‘CANCER’ is used to describe a wide variety of malignant diseases. The factors involved in the causation of many of these diseases still remain unknown. Next to Heart Disease, Cancer is a most common cause of death. Cancers could be grouped into three major groups;1. the Carcinomas which arise in endodermal or ectodermal tissues known as epithelial tissues. Breast and Colon Cancers are well-known Carcinomas. 2. the Sarcomas are fleshy tumors, arise from mesodermal tissues, the connective tissues like bone, cartilage, and fat. Sarcomas of soft tissues constitute only 1 percent of all malignant tumors and they may occur at any location in the body. Roughly twenty different types of Sarcomas are described. 3. the Lukemias and the Lymphomas which are derived from the blood cells and the cells of the Lymphatic system. A fundamental principle of Cancer treatment is to establish the pathological nature of any growth suspected of being neoplastic before making decisions about its management. This usually involves a ‘BIOPSY’; taking a sample of the tissue from the suspected lesion and subject it to a microscopic examination and a histological evaluation to determine the nature of tissue and the cell type involved. While an early diagnosis is very helpful, the survival of the victim mostly depends upon the nature of Cancer.

TWO RARE CASES OF CANCER IN PERFECTLY HEALTHY INDIVIDUALS :

I had served as the Regimental Medical Officer at the Army Ordnance Corps Centre, Seunderabad, India from December 1978 to January 1984. I would like to narrate the stories about two individuals who had served at the AOC Centre who were in great physical shape prior to becoming victims of Cancer. The first case in 1979 involved Lieutenant Colonel D’ Souza, the Commanding Officer of No. 2 Training Battalion of the Centre. He was very tall, handsome, with a well proportioned body built. He was picture-perfect and had no unhealthy habits like smoking. He walked into my office around 10.00 A.M. with a slight expression of a concern on his face. He came to ask me about a pea-sized, painless swelling he had noticed on the gum pad of his left upper incisor tooth. The swelling was of very recent origin and could be easily noticed while brushing teeth. It looked reddish and there was no other discomfort caused by it. I had immediately diagnosed it as a neoplasm(new growth) as I could easily exclude all other possible conditions. He had perfect healthy teeth and gums and had no other medical problems. The Military Hospital and the Military Dental Centre are at a short distance from the AOC Centre. I had told him that I would not prefer to refer him to either of those two places. I had told him that the only way to know the diagnosis of that tumor would be by getting a Biopsy report and the earliest way to obtain the Biopsy report would be from the Osmania General Hospital, Hyderabad which is a Post-Graduate Medical Institution which conducts medical research. The Military Hospital has no qualified Histopathologist and cannot provide the report that I had wanted quickly. He proceeded to Hyderabad and had undergone the Biopsy test as recommended by me. I remember Col.D’Souza and my meeting him at AOC Centre Medical Inspection Room. He had returned to me with the report after two days. Col.D’ Souza fully understood the gravity of the situation and the report that he had in his hand. Apart from the Military Hospital, we had hundreds of Specialists in the twin cities of Hyderabad and Secunderabad. He never thought of asking any one or consulting any one about his illness. He had trusted me because he knew that I was truly involved and concerned about his welfare. The Biopsy report suggested that the tumor was an ‘Angiosarcoma’, a very uncommon malignant neoplasm derived from the blood vessels, the vascular endothelial cells that line the inner walls of the blood vessels. It is al
so an extremely unusual presentation for this type of tumor. When we had discussed the Biopsy Report, he was very calm, very well composed and took my advice without show of any anxiety. I am very happy for having met a brave man like Col. D’ Souza. On the very same day, I had arranged for his admission to the Military Hospital, Secunderabad and an immediate transfer to the Malignant Disease Treatment Centre in Pune. In spite of this early diagnosis and very prompt hospital admission and Cancer therapy, he did not survive and I had missed seeing him again.

The second story involved a very fine athlete who had already participated in several events both at National level and at International level and had won prizes. The top athletes who belong to the Army Ordnance Corps are usually posted at AOC Centre, Secunderabad and the Centre took a great pride in having them there. This had happened in the year 1983. This tall, well-built and muscular sportsman who held the military rank of Junior Commissioned Officer, had noticed a painless swelling, about the size of a small orange, on his trunk, on the back near his waistline and had immediately reported his problem to his Battalion Commander at the Centre. The Battalion Commander wanted to get the swelling treated immediately and took this athlete direct to the Military Hospital and showed him to Lieutenant Colonel TMB Nambiar, a Surgical Specialist.Dr. Nambiar, whom I knew personally, is a kind and compassionate person, soft-spoken and gentle in his attitude and bearing. This Surgical Specialist who was apparently preoccupied with his plans for leaving the military service made no attempt to arrive at a proper diagnosis. He had misdiagnosed the swelling as a pyogenic abscess and immediately performed a minor surgical procedure called ‘incision and drainage’ to empty the contents of that swelling on the back.He made no attempt to send a sample specimen to the Hospital Laboratory to ascertain the nature of infection if any.The Surgical Specialist had further prescribed a course of antibiotic injections for seven days and had assured the athlete that the problem would be resolved.I have problems with this type of case management. The lump/swelling in the back was soft like an abscess but the clinical findings suggested that the lump was seated in the muscles and there was no reason to consider it to be infective in origin. The patient had no underlying problems like Diabetes or infections like Tuberculosis, or poor nutrition or lack of personal hygiene that could have contributed to a pyogenic abscess. If it was an abscess, he still needed admission to the Hospital and a full evaluation of any underlying disease. It would be very exceptional for a healthy male adult to suffer from a large abscess. At the end of the antibiotic treatment, the Surgical Specialist was gone and was not available for making an evaluation of the patient’s condition. This fine athlete and his Battalion Commander came over to my residence in the evening to discuss this health problem. The Surgeon had assured them that the swelling would go away and it was not so. The swelling had not only reappeared after the surgery, it was also growing in its size.When they walked into my living room and as I asked them to be seated, I could immediately recognize that the athlete was in great danger and that was an insight, an impression I got from his facial expression. He had briefly explained his story and the treatment as an outpatient at the Military Hospital. I had examined the swelling on his back and could immediately diagnose it as a very serious case of a Cancer, a malignant tumor which had already invaded other tissues and had spread to the nearby lymph nodes. This Cancerous growth was in his back muscles and is often described as Rhabdomyosarcoma. I was astounded by the fact that a qualified Surgical Specialist in the rank of a Lieutenant Colonel at the Military Hospital had misdiagnosed the condition and had subjected this patient to unnecessary treatment. The diagnosis of Cancer was so apparent in this case, I did not need a Biopsy report to confirm it further. I regretted the fact that precious time was wasted by this Surgeon. I had arranged for his admission to the Military Hospital and an immediate transfer to the Malignant Disease Treatment Centre at Pune. Within a few hours of time, after consultation at my home, this great athlete who was in the prime of his Sporting career, boarded a train in Secunderabad on way to Pune for his Cancer treatment. Just like Col. D’ Souza, this Junior Commissioned Officer received my advice with a sense of calmness and I take pride in the fact that Indian Army has brave and courageous people who receive news about life threatening conditions with a sense of maturity and without show of any anxiety.

In both of these cases, I was very hopeful that they would survive and return to the Unit. Unfortunately, their Cancers were very aggressive in nature and the Cancer won this unfair battle during their initial course of treatment at MDTC, Pune.

MY RECOMMENDATIONS TO INDIAN ARMY MEDICAL CORPS :

I had reviewed the Manual of Health for the Armed Forces-1968 Edition. Chapter VI – Assessment of Health and Hygiene in the Armed Forces and Chapter X- Health Care deal with the duties of Regimental Medical Officer. We should involve the Medical Officer to a fuller extent in case management. It should be mandatory for the Medical Officer to visit his Unit personnel who are admitted to a Hospital and enter a written report about the case management. The Unit Medical Officer should be officially informed when his patients are placed on ‘SERIOUSLY ILL LIST’ or ‘DANGEROUSLY ILL LIST’. This official notification should constitute the authority for the Medical Officer to visit his patients in the Hospital and if required to proceed on Temporary Duty to the Hospital. The Medical Officer should be given additional training to provide psychological and grief counselling to his patients and to the immediate family members. The Medical Officer should be able to refer his patients and their family members for further appropriate psychological counselling. The rules for medical evacuation should be amended and we should authorize and provide qualified medical attendants to support the mental, and social well-being of individuals apart from providing routine curative care and management during the journey. The Army Medical Corps is not a Charity providing Compassionate Care. We have a duty to provide the Health care that we provide and we need to express the spirit of our Motto through our actions. If there is no freedom from sickness and disease, we can still excel in providing mental comfort and social support to our patients and their immediate family members. Kindly share my concerns with others who may be serving in Uniform and Army Medical Corps should deliver in accordance with its Motto. If you have any questions, please contact me using my e-mail address:

rebbapragada@sbcglobal.net

Bhaja Govindam – Part III :

The Art of Diagnosis has no further value apart from knowing the nature of the threat faced by humans and there are several medical conditions where the outcome ultimately depends upon the nature of the underlying problem. However, knowing the reality is equally important and it helps us to face the consequences and at the end the sweet name of ‘GOVINDA’ is the only consolation we have while preparing to lose the battle against Death.

Bhaja Govindam, Bhaja Govindam,

Govindam Bhaje muudha matey,

Sampraapte Sannihitey kaaley,

Nahi, Nahi rakshati Du krun karaney.

Dr. R. Rudra Narasimham,

Kurnool Medical College, Kurnool, Andhra Pradesh, India.,

M.B.B.S., Class of April, 1970.

OLD FLAMES NEVER DIE – A PLEDGE TO MY VALENTINE

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THE LIVING TIBETAN SPIRITS  :

My consciousness got exposed to the Spirits of some young Tibetan men whose untimely deaths I had witnessed. I dedicate this blog post to those Living Tibetan Spirits that continue to live in my consciousness.

WHO IS MY VALENTINE ?

The word Valentine as a noun describes a Sweetheart chosen on St. Valentine’s Day(February 14). A note or greeting card sent to Sweetheart on this Day containing a message of sentimental love is also described as  a Valentine. This year’s Valentine’s Day is of special significance to the Tibetan people as  they ushered the New Year of Iron Tiger Year 2137 of their Lunar Calendar. On this Valentine’s Day, I want to assure my Valentine that the burning passion aroused in me is alive and has not died.    

After attending Kurnool Medical College, Kurnool, Andhra Pradesh, India, I had joined Indian Army on July 26, 1970. On July 26, 1971, I had completed my military and professional training at Military Hospital, Ambala Cantonment, Haryana and was fully ready to serve the nation in my role as a Medical Officer of the Indian Army Medical Corps. I left Ambala on September 21, 1971 on my first posting. On September 22, 1971 after reaching my new Duty Station I met my Flame. The Flame kindled a fire in my heart. That fire still burns.   

"Old Flames Never Die" - A Pledge to my Valentine. These Flames kindled a fire in my heart on September 22, 1971 and that fire still burns. I shall keep the Flame alive in my future.

As the saying goes, “Old Flames Never Die”. The Flame lives in my Consciousness. On this Valentine’s Day, I pledge that I will keep the Flame alive in my future. The message that I want to send to my Valentine is ; “My past, my present, and my future is a continuum.”  I share the pain and grief that my Valentine has experienced in the past and is experiencing now. We both understand the Challenge, share a common hope and expectation of a better future. The Spirit of my Valentine languishes in Darkness. The darkness of military occupation has enveloped my Flame threatening her very existence. She needs a breath of fresh air to survive. I promise that I am the Breath of my Valentine’s life.   

I seek the Compassion of Buddha to keep the Flame Alive and fulfil the Pledge made to my Valentine.

The Butter Lamps lit in my Unit’s Gonpa( Gompa ) are still glowing. I seek the Compassion of Buddha to keep the Flames Alive.   

Buddham Saranam Gacchami,   

Dhammam Saranam Gachhami,   

Sangham Saranam Gachhami.   

I seek the Path of Triple Refuge to keep the Old Flames Alive. I seek the Refuge of Buddha. I seek the Refuge of ‘Dharma’. I seek the Refuge of ‘Sangha’.   

The Path of Triple Refuge to keep the Old Flames Alive.

 TIBETAN NEW YEAR-LOSAR – IRON TIGER YEAR   2137 :  

Tibetans celebrate their New Year in the traditions of their Lunar Calendar. The Valentine’s Day this year has coincided with their New Year – LOSAR celebration.In due recognition of the pain, suffering, and misery that is  experienced by Tibetans inside Tibet, the Tibetan Community has refused to celebrate LOSAR this year. I send my greetings of  “TASHI DELEK” to all of my former associates and people who  defend Tibetan Identity.  

Please view the related blog post titled ‘The Problem of Tibet – Evict the Occupier’  

http://bhavanajagat.wordpress.com/2010/07/06/the-problem-of-tibet-evict-the-occupier/  

Dr. R. Rudra Narasimham,  

Kurnool Medical College, Kurnool, Andhra Pradesh, India,  

M.B.B.S.,  Class of  April,  1970.   

NINE YEARS SERVICE MEDAL – A SALUTE TO THE LAW OF TEMPERANCE

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NINE YEARS LONG SERVICE MEDAL AWARDED BY INDIAN ARMY SYMBOLIZES GOOD CONDUCT AND TEMPERANCE

THE LAW OF TEMPERANCE  :

John Milton (1608 – 1674), in his greatest poetic achievement of ‘PARADISE LOST’ describes Man’s First Disobedience of God, and the loss thereupon of Paradise wherein Man was placed. Adam, the first Man who was created in God’s image and likeness brought Death into the World. God declares that Adam and Eve could no longer abide in ‘Garden of Eden‘, the Paradise. God sends Angel Michael with a Band of Cherubim to dispossess them. Michael reveals to Adam the ‘Law of Temperance’ which could help him to live for many long years. Angel Michael also comforted Adam by assuring him that if he observes the ‘Law of Temperance’, Death would be like the gentle act of gathering a ripe fruit when fully mature.

PARADISE LOST, BOOK XI ( 520-540)  :     

 

 

 

In John Milton's epic poem of Paradise Lost, angel Michael explained 'The Law of Temperance' to Adam, the first created man to face the threat of death.

 

I yield it just, said Adam, and submit.

But is there yet no other way, besides

These painful passages, how we may come

To Death, and mix with our connatural dust ?

There is, said Michael, if thou well observe

The rule of not too much, by temperance taught

In what thou eatst and drinkst, seeking from thence

Due nourishment, not gluttonous delight,

Till many years over thy head return:

So maist thou live, till like ripe Fruit thou drop

Into thy Mother lap, or be with ease

Gathered, not harshly pluckt, for Death mature:

THE NATURE OF TEMPERANCE  :

The essence of Temperance is choosing moderation and deliberately avoid excess. In Indian Culture, and Tradition, living in moderation and living in virtue are almost identical. Socrates suggests that one should “choose that which is orderly and sufficient and has a due provision for daily needs”. He compares the intemperate man “to a vessel full of holes, because it can never be satisfied”. Socrates describes the temperate man as able to satisfy his limited desires, whereas the intemperate man of boundless desire, can never pause in his search of pleasure. According to Freud, when “the ego learns that it must inevitably go without immediate satisfaction, postpone gratification, learn to endure a degree of pain, and altogether renounce certain sources of pleasure”, it “becomes ‘reasonable’, is no longer controlled by the pleasure-principle, but follows the reality-principle”, which seeks ” a delayed and diminished pleasure, one which is assured by its realization of fact, its relation to reality”.

TEMPERANCE AND COURAGE  :  

 

 

 

 

 

 

Saint Thomas Aquinas and 'The Law of Temperance'.

 

Thomas Aquinas has defined Temperance as “a disposition of the soul, moderating any passions or acts, so as to keep them within bounds. Temperate refers to a man who abstains from bodily pleasures and delights in this very fact. A man not only acts temperately, but is temperate in character, when his desires are themselves habitually moderated to be in accord with reason. A temperate man is not pained at the absence of pleasure or by his abstinence from it. Temperance contributes the virtue of Fortitude which strengthens men against “the enticement of pleasure” as well as against the fear of pain. A man who is able to stand firm against the onslaught of pleasures is more able to remain firm against the dangers of death. And so “Temperance can be said to be Brave”. The endurance of pain is central to the nature of Courage. Temperance and Courage are not distinct virtues as both are based upon an ability to stand firm against pain and danger.

NINE YEARS LONG SERVICE MEDAL – A SALUTE TO THE LAW OF TEMPERANCE  : 

During my service in the Indian Army Medical Corps, I learned the values of Temperance, Fortitude, Courage, and delaying gratification of desires, and avoid seeking physical comforts and pleasures.

 

During the first nine years of my Indian Army Service, apart from taking part in the War of Liberation of Bangladesh, I had participated in a variety of Army Operations that keep the men ready and prepared for a battle. Military Training and Service can be best described as habituation for a temperate character. The nature of Army Operations and Tactics always demand overcoming the onslaught of sense pleasures and voluntarily delaying the gratification of personal desires. A life style based upon physical ease and comfort, and indulgence in food and alcohol is not compatible with the Army way of life. The nature of Army Operations is influenced by terrain, climatic conditions, distances and the availability of transportation. There is no scope to cater for physical comfort, relaxation, and entertainment. The supply of rations and food provisions is limited because of the problems of their bulk and weight. Army Rules and the Code of Conduct would emphasize that men should honor their commitment to serve more than anything else. Such commitment to Serve with Honor would only be possible only when the man in uniform lives in accordance with the Law of Temperance.

Dr. R. Rudra Narasimham,

Kurnool Medical College, Kurnool, Andhra Pradesh, India,

M.B.B.S.,  Class  of  April,  1970.

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