The C2S blog draws on the arts, the social and biological sciences to explore the many meanings of health and "dis-ease." Designed to be a locus where patients, their families and professionals can meet on a level playing field, it is the natural off-shoot of the Cell 2 Soul Online Journal. We encourage the submission of ideas, essays, poems, stories, humor, and timely reviews relating to the humanities and health care.
The great haiku master, Matsuo Basho (1644 - 1694) wrote, "The bones of haiku are plaineness and oddness." Little has changed.
For National Poetry Month, The New York Times asked readers to write haiku about the City. The response — more than 2,800 submissions in 10 days — was as impressive. NYC in 17 Syllables is an inspirational and optimistic selection that crowdsources the talents of uncommon, common people.
Photo of Sutton Park by Gabriela Nagy, 4/16/14
subway to the beach two strangers in the first car comparing surfboards
The house was old but had personality! The small space in front paved with red rectangular tiles, the arched doorway with red bougainvilleas growing in riotous profusion, the well by the side and the small garage filled with sand. White jasmine bushes wafted their heady scent into the night air filling the house with an intoxicating fragrance. The drawing room and the kitchen, the nerve centers of the house adjoined each other. My father used to always say that this arrangement ensured that the ladies of the house could keep an eye on the main entrance from the kitchen. The drawing room had wooden windows with colored glass panes. Dark blue, green, and violet panes tinted the entering light in rich colors. The roof had wooden rafters and the floor was a dark, warm, rich red. There was a wooden showcase encasing a beautiful image of Lord Krishna which used to dominate the room. In the modern era the LCD television has pride of place in most drawing rooms and sadly the same has occurred in my father’s ancestral home.
My grandmother was a remarkable woman. She was small, around five feet one; as she aged her spine gently curved dragging her closer to Mother Earth. She was always immaculately dressed in white and was perpetually busy with household matters. She was a matriculate under the old British system and used English precisely and succinctly. She had studied in Moyan Girls High School in Palakkad, Kerala during the 1920s and 30s and it was a strange quirk of fate that over sixty years later I appeared for the medical entrance exam successfully at the same school where my grandmother had studied.
Adjoining the drawing room was a store room, a place I used to dread as a child. Palakkad was still an agricultural town and we used to keep our pesticide spraying equipment there. The bright copper container, the long snaking tube and the wide spraying nozzle used to terrify me. I remember quickening my steps when passing nearby and turning my head to the other side trying my level best to avoid looking into the dark and dangerous room. Inside, the house was dark and cool like old houses everywhere. I had heard my grandmother describe her purchase of an old mud house in the 1940s and remodeling it to the present structure. In the center of the house was a room surrounded by verandas. The room had a large circular table and some shiny old trunks which my grandmother had bought back with her on her return from Malaysia. The room had a hinged trapdoor in the roof which opened to the dark attic.
I was both fascinated by and scared of the attic. It was dark, low and filled with soot. There was a musty odor. The attic was full of old ‘things’ which my grandmother had collected over the years. There was a rich and eclectic collection of books and odds and ends. The dark rooms had wooden almirahs with glass mirrors. These were painted a rich, chestnut brown. The doors in the house were thick and heavy requiring considerable expenditure of effort to open and close. The doors had wooden doorsteps and you had to high-step these while going from one room to another. I often forget about this impediment to progress and used to crash heavily against the doorsteps.
The ‘other side’ of the house was my favorite with two large rooms and a dining room and kitchen. The two bedrooms had wooden windows which opened on a small coconut grove. The high wooden beds were richly carved. I have always been fascinated by coconut trees which I subconsciously associate with Kerala, God’s own country. The green fronds gently swaying in the breeze, high above the ground are a sight for the Gods.
The dining room had three glass tiles in the roof through which sunlight slanted into the room. I have fond memories of hot afternoons when I used to enjoy fragrant, parboiled rice and rich, spicy fish curry seasoned with coconut. The meal was tasty but ‘hot’ and I used to get up from the dining table drenched in sweat! Palakkad is one of the hottest places in Kerala and the mercury used to rise above 40 degrees Celsius routinely during summer. The kitchen with its wood burning fire places was an endless source of fascination. The room was dimly lit with only two light bulbs and in those days Kerala used to suffer from chronic low voltage. The orange flickering flames used to project strange shadows on the grey walls.
Childhood was a time of wonder. We used to visit Kerala during the summer holidays. It was a long train journey and we used to pass through the burning heat of Andhra Pradesh en route. The Sun was red, the soil was red and barren and a hot wind used to blow turning the train compartment into a hot air oven! We used to reach Palakkad in the early hours of the morning and Kerala used to spread her welcoming mantle of green. My mother used to awaken me from a deep slumber and the magical land stretched on both sides as the train entered God’s own country. The monsoon used to arrive with a bang in early June. In those days the rains used to be heavier than today. There was thunder and lightning. The rain began with the crack of dawn and continued throughout the day and often during the night. The rain was heavy and accompanied by strong gusts of wind. The water dripping down from the roof used to form small puddles on the ground. I enjoyed scampering among the puddles much to the annoyance of my parents.
It was the age of wonder. I remember watching a series called ‘The Wonder Years’ on television. As I grew up, slowly the wonder started to disappear. The area also began to modernize. New large houses were built, terraced roofs began to replace tiles and the National Highway 47 was constructed passing right behind our house. The author Peter Matthiessen writes in his book ‘The Snow Leopard’ that as we grow up we begin to lose the sense of wonder with which we used to view the world when we were young. The child is one with the world around him and the sense of a separate ‘I’ has not yet formed. As we grow we retreat into defensive walls and crannies away from the grand stream of life. It is ironic that as we begin to take greater control of our life we lose our sense of wonder. We begin to resent this loss either consciously or subconsciously which is richly expressed in our art and culture. Writers, poets and painters have long grappled with it.
I am aware that my sense of wonder, of being one with the universe may never return. The sense of grief and loss is palpable. As an adult there are only brief and infrequent episodes when I can unite back with the universal Soul. These episodes are to be cherished and treasured!
Author: Dr P Ravi Shankar was born in Kerala and spend his childhood and teens in the megapolis of Mumbai, India. He was educated in medicine at Kerala, and Chandigarh and in medical education at Coimbatore in South India. He has always been fascinated by nature and mountains and after his post graduation journeyed to the lakeside city of Pokhara, Nepal in the foothills of the Annapurna Himalayas where he taught at the Manipal College of Medical Sciences. He started a voluntary medical humanities (MH) module at the institution. Later he shifted to the historic city of Lalitpur in the southern part of the Kathmandu valley where he conducted a MH module, Sparshanam for all undergraduate first year medical students at KIST Medical College. In addition to MH, small group learning and medical education
Dr Shankar is keenly interested in promoting rational use of medicines and has been closely associated with the Discipline of Social and Administrative Pharmacy at the Universiti Sains Malaysia at Penang, Malaysia where he is a honorary lecturer. In 2013, Dr Shankar journeyed to the Caribbean enamored by his friends’ description of pristine white sands, azure blue seas and warm sunshine. At present he is at the Xavier University School of Medicine in Aruba, Kingdom of the Netherlands where he is a Professor of Pharmacology and Chair of the Curriculum Committee. He has been facilitating a MH module for first semester medical students at the institution since February 2013. The module is conducted in small groups and uses case scenarios, paintings, role-plays and activities to explore different aspects of MH and has been well received by students. Email: Dr. P Ravi Shankar.
"The mass of men lead lives of quiet desperation... A stereotyped but unconscious despair is concealed even under what are called the games and amusements of mankind. There is no play in them, for this comes after work." H. D. Thoreau
Thoreau sequestered himself at Walden. The erstwhile neurologist, Dr. John Kitchin, fled a medical practice to in-line skate on the boardwalk. On any given day, "Kitchin [can be seen] meticulously skating up and down San Diego's promenade. Disillusioned with a life that had become increasingly materialistic, he abruptly abandoned his career and moved to a studio by the beach. The locals call him Slomo, knowing little about his past life, but cheering and high-fiving him as he skates by in slow motion. He has become a Pacific Beach institution."
If you missed the provacative and, for some, inspirational NY Times article, click on SLOMO.
To Cure Sometimes, To Relieve Often, To Comfort Always
Photo taken from "The Raw Story."
Shaving William is something like performing surgery, and when the weather permits, our back porch becomes our operating room.
So begins "Caring for William," a recent New England Journal of Medicine essay by Robert Jones. It will resonate with many of you for some time to come.
Robert Jones is an unusual medical student. He has chosen to divide his life between two very different worlds: a hospital, where I'm a medical student, and a homeless shelter, where I live and work... the boundaries often blur...
The New England Journal of Medicine's articles are often stodgy, pedantic and dense. Occasionally, a piece blazes with poignant insights. Caring for William is one of these. Because this link may not work for you since most NEJM articles are not free open-access, I have provided access to the essay here: Download Caring for William (but I will remove it in three days, so as not to incur the wrath of NEJM). If you want to read it later, contact me and I'll send you a pdf (it's the equivalent of a photocopy and should be okay with the publisher).
Jonah Zuflacht, a first year medical student at Columbia P&S has this comment: "Robert Jones' essay artfully portrays his relationship with a schizophrenic, homeless man. It serves as both a window into the absurd nature of the system in which he (and other soon-to-be physicians) will practice and a reminder of what drew many of us into medicine to begin with."
Ann Musser, 41, preoccuppied with surgery and chemotherapy for advanced ovarian cancer, registered her dog, Pumpkin, late, after receiving letters from the state. Since she was in contempt of court, she was handcuffed and taken to jail. The dog license fee in Massachusetts is $5.
If any of you have overdue library books in Massachusetts, plese be careful.
As starlings gather in the evenings to roost, often they will participate in what is called a murmuration — a huge flock that shape-shifts in the sky as if it were one swirling liquid mass. Often the behavior is sparked by the presence of a predator like a hawk or peregrine falcon, and the flock's movement is based on evasive maneuvers. There is safety in numbers, so the individual starlings do not scatter, but rather are able to move as an intelligent cloud, feinting away from a diving raptor, thousands of birds changing direction almost simultaneously. The question that has had scientists stumped is how a bird, hundreds of thousands of birds, can elude the nearest danger, sense the shift and move in unison? The group protects its members. Safety in numbers -- but even more.
Sometimes, we can just watch and wonder -- there are things that are beyond our ken.
Art is powerful preventive medicine. Looking at a picture is like walking through an endless series of doors, with each succeeding door leading us deeper and deeper into a rich experience.This journey stimulates our minds, our emotions, our souls; it makes us more alive. Ultimately the esthetic experience heals us and makes us whole. -- Robert Pope, Illness and Healing, Images of Cancer, 1991.
Susan Gubar in a February 7, 2014 NY Times essay, Living with Cancer: An Artist's View writes: "Though we accept ambiguity in art, it is harder to accept in science, harder still in medicine."
Robert Pope (1956-1992) was a dedicated Nova Scotia artist who died of Hodgkin’s Disease at the age of 36 after a ten year battle with the illness. (The link to the Rpbert Pope Foundation is not live now.) His work "reminds us that often patients and caregivers cannot fathom what we sign up for. Even when physicians try to communicate the consequences of their prescriptions, patients need to make a leap of faith.
"Mr. Pope’s paintings make one wonder: Is cancer treatment a form of religion, a means of transformation that involves its own rituals, trials, high priests, sacraments, vestments and bodily signs for people in need of a miracle and convinced that we have to be stripped of everything before we can be reborn?"
Even after two weeks, Susan Gubar's article still resonates with me. Read it if you have a chance, and the moving comments as well.
Steve Sobel is a practicing psychiatrist in northern Vermont. "A 500 Pound Amoeba" is a collection of 10 compelling vignettes of patients with psychiatric illnesses. These comprise depression, mania, OCD, body dysmorphic disorder, borderline personality, generalized anxiety disorder, schizophrenia, acrophobia, psychotic depression, and dementia. The stories are told with great sensitivity. Each one is divided into two parts. The first describing the illness as appreciated from the patient’s vantage point and the second explains the clinician’s approach and touches on the doctor-patient relationship.
We have all known patients like the composites Dr. Sobel eloquently conveys. As physicians, we have all had patients like these. Sobel’s narrative style is easy to read and follow. These tales afford profound insights into the illnesses covered.
This slender volume of less than 130 pages will make compelling reading for physicians, mental health professionals, trainees, medical students and all others with an interest in mental health. Sobel has a humble, gentle, compassionate writing style and the tales are memorable. The narrative form employed also serves as a template for the presentation of similar patients. Reading "A 500 Pound Amoeba" one recalls Oliver Sacks' "The Man Who Mistook His Wife for a Hat" but I found Sobel's book less didacticand more humane.