Is there a difference between eternal sleep and death?

Ashok and Chandra are sitting in a bar. It is quite late and both had a few drinks. It is quite late there are only a few patrons in the bar.

Ashok: Do you think there is a difference between eternal sleep and death?

Chandra: Huh? What do you mean by eternal sleep?

Ashok: It is a sort of sleep from which you never wake up. Your heart continues to beat, you continue to breathe but you never wake up again, never start a day again, never perform any conscious activity.

Chandra: Do I get a choice?

Ashok: Say that you, you are forced to choose between eternal sleep and death. What would you choose?

Chandra: Let me first thresh these ideas of eternal sleep and death a bit bit then I will choose. I assume by death you the cessation of all my bodily functions – heart, brain the whole lot? If that is so, disregarding the idea of an afterlife, death would mean oblivion for me. Not only it would mean the cessation of all conscious activity, it would also mean the loss of accumulated experiences of my existence. I would cease being an entity and will be reduced to my constituent matter.

Ashok: As philosophers have said, you didn’t exist before you were born. It didn’t bother you. So why should it bother you when you will not exist after you die?

Chandra: The difference is that I didn’t have my memories nor was I aware of my non-existence. Now that I am aware of the possibility of non-existence, I dread it. I am inseparable from my memories and my experiences – they make me what I am. Death implies the ultimate loss of my existence.

Ashok: If you put it like that, wouldn’t any disease causing the loss of your memory will also mean the loss of you as  being?

Chandra: Yes, it will certainly mean so. If I lost all my memories, then I would not be able to recognize you as Ashok and neither will the ideas and experiences that have formed my personality, made me the person that I am will also cease to exist. It will be a different person with a blank slate, unrecognizable to you and even to myself.

Ashok: Well certainly there are conditions that change a person.

Chandra: Yes certainly. Coming back to your question, if we go on an eternal sleep, I will still have all my experiences and all my memories. I will be intact as a person. My memories will give rise to dreams and I will continue to exist in them and through them even though I may be unable to to exert any effect in the real world. In eternal sleep, I will still have a mental life even if I never wake up and I will cling to that. It is better than the non-existence of death.

Ashok: What if it is a dreamless eternal sleep?

Chandra: That will be too cruel and death in a sense.

At that time, the bartender said it is time to close and the two of them drank their last glasses for the night.

Blunt trauma abdomen with pancreatic laceration

In our last admission day, a 23 year old male patient presented to the emergency with a history of blunt trauma abdomen 4 days back. He was riding a motorcycle (without helmet of course) when he skidded and fell down. He was previously admitted at an outside facility where he was managed conservatively. When he presented to us, he was conscious, alert and cooperative, without any significant external injuries. He had no pallor, jaundice, cyanosis, clubbing or edema. His pulse was 118/min, BP-122/70 mmHg, RR – 26/min and was afebrile. His abdomen was distended, tense and tender. Hepatic dullness was not obliterated and IPS was absent. His chest X-ray and straight X-ray abdomen did not show any significant abnormality.

He had CT scan of the whole abdomen done two days after the injury which showed grade III hepatic laceration involving segment VII and VIII and laceration of the pancreas at the body along with hemoperitoneum. We did not have access to emergency ultrasound so an abdominal tap was done which revealed presence of blood. The visiting surgeon was informed and a decision was taken to undertake emergency laparotomy for the patient. Then there was a sudden significant development in the patient. His SpO2 in room air was found to be 83%. It debated whether to do a repeat X-ray or to do a pleural tap. It was decided to do b/l pleural tap which revealed b/l hemothorax.

 

 

The patient was taken to the operation theatre and before laparotomy, b/l chest drains were put in. About 500 ml of blood came from each drain following the SpO2 rose to 97%. We then proceeded to laparotomy. The abdomen was opened by midline incision. On opening, the abdomen, blood was seen within the abdominal cavity which was sucked out. There was an estimated 2 liters of blood within the abdominal cavity. On exploring, the infracolic compartment was found to be normal. A 10 cm laceration was seen in the antero-superior surface of liver with a parenchymal depth of 1 cm. there was no active bleeding from it was decided to leave it as such. There was extensive saponification in the supracolic compartment . The lesser sac was entered by dividing the gastrocolic ligament. On entering the lesser sac, dark coloured serous fluid came out which was sucked out. there was extensive saponification along the body of the pancreas and the pancreas was highly friable. The exact site of the pancreatic laceration could not be identified. The spleen and the duodenum was found to be normal. It was decided to put a drain in the lesser sac and close the abdomen. A feeding jejunostomy was done to maintain nutrition in the post-operative period as possible pancreatic fistula was anticipated.

The patient is presently in 4^th post-op day with a high leucocyte count – 21000/mm3 and the output from the drain in the lesser sac is about 75ml in 24 hrs. Both the chest drains have become non-functional but the patient is having tachyapnea. He is scheduled for a CT thorax and upper abdomen after 2 days. Feeding through FJ has been started.

 

The content of the popular media is a decent reflection of the state of the society. There you go, I have stated my thesis at the beginning and the rest of what follows is an attempt to show what really follows when you accept this premise. Let us undertake an experiment – watch this advertisement –

 

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It’s a popular advertisement about a printer. What was your reaction to it? Do you like it or feel indifferent? Actually the advertisement or rather the content of it and the subtle psychological message it attempts to send to its target audience is quite telling about the state of the current generation of young adults, you know, those of us born in the late 80s or 90s, who are now getting jobs, getting married, having families of their own. In short those of us who have the purchasing power. The advertisement starts by depicting a scene which appears to be in the house of the modern upper middle class Indian family. The dad is watching the television; the mom is at the table with the daughter. It appears that the mother is helping the daughter in doing some work, probably homework. Then we see the son and the crisis. The Science project is due on Monday but it is already Sunday 9 pm. The mother gives the son an indignant look and then the family gets together and with the help of the printer being advertised they save the day and win a prize in the process.

 

 

Thus far nothing spectacular jumps out at you, does it? It just appears as a garden variety run of the mill advertisement. But shall we delve in to the advertisement a little more deeply? Firstly, even though the advertisement superficial depicts a modern Indian family but in reality it emphasizes the stereotypical Indian family equation. The father is watching the TV, distant, aloof while the mother is helping the kids. Is that all? You know it is a trick question. Of course that’s not all. What is important here is where the mother and her little girl are studying. See the image above. Do you see the salt and pepper pots on the table? They are studying on the dining table, indicated by the presence of a pot, probably of salt and the positioning of 4 chairs around the table and its proximity to the kitchen. Way to show women their place! And I thought this to be a modern Indian family. May be is it, may be it is me who has got it backwards. Or not. How would it feel it they had shown the mother to watch TV in the other room not caring for her children?

 

Now we come to the crisis it self. The viewers are first informed about the crisis in the form of a sticky note posted on the refrigerator that the science project on due on Monday. This singular fact is of profound significance because it implies either that the mother or the father did not use the refrigerator a single time during the day or that like their son, they themselves forgot about the project. I think that the second scenario is much more plausible.

 

The fault of forgetting is as much of the parents as it is of their son. One might even argue that the parents wouldn’t have remembered unless their son first noticed it. They were blissfully oblivious, the father more so than the mother.  Now to compensate for their faulty parenting they resort to a gadget. It is a ticket out of the mess which they are in because of their own short coming. What does the ad tell us? You can procrastinate and even teach your children to do so because you have the gadget instead actually inculcating in them the value of timeliness. It’s ‘your get out of the jail free’ card. You like this ad because it assuages your guilt for not paying enough attention to your kids, you like this ad because it lets you let you take the easy way out. The answer is not the printer or any other gadget that you can buy because the problem is you. The problem is your lack of time management, your procrastination. But you don’t want to hear that.

 

The singular fact about the advertisement that the ad makers thought that it would work. Telling.

A night

During the course of our life there are certain events which are of such profound significance that they tend to shape us as a person, they go on to define who we are. They may not be very important to the rest of the world but their significance lies in the intense personal emotions they invoke in the handful of persons who are the actors and spectators of such incidents. Often we do not realize the impact of the event when it is actually taking place, only when we look back and reflect we realize how indelibly such events have altered us.

It was my first night in the department of medicine as an intern. We were in our unit room, a stuffy little room adjacent to the ward. There were four of us, me, my co-intern and two of my seniors, one was the house staff and the other post graduate trainee. I was the greenhorn. It was a summer night. Those of you, who have been to Kolkata, or any other tropical city, can imagine how a summer night is here. Even at night, the air was still hot from the merciless frown of the day time Sun, humid and stale, laced with the invisible agents of tuberculosis and perhaps a host off other bacteria, viruses and may be some fungi all jostling for a suitable host to plant their seed. The state of the room didn’t improve the conditions much. There was a small window but without any effective ventilation it sat there mocking us, its rusted iron bars grinning at us like carious teeth. There was a small table scattered with the tools of our trade and the four of us sat around it, administering to the assorted ills, aches and pains of the 200 patients in the ward and all those who might get admitted during the night.

There was a steady trickle of patients being admitted through the night, the usual sample of chronic kidney disease, asthma attack, heart failure, organophosphate poisoning and so on. There were no patients of myocardial infarction, they get directly admitted to the cardiology department from the ER. I had not realized how time flew by, there was always some thing or the other that needed to be done – a blood work, a ryle’s tube insertion, so on and so forth. And then it happened. A call, the nurse asking me to have an urgent look at a patient who the nurse thought was not doing quite so well. Off I went with my stetho to the ward. If you have gone to any old government hospital, built before independence, you can see buildings have high ceilings with huge doors and the fans hang from the ceiling on long metallic poles. This was one such ward. When I entered, it was silent except for the metallic clangs of the old ceiling fans which were perhaps even older than me.

As I approached I saw that the patient was a young boy, not quite so young to be in the pediatrics ward yet not old enough to be called a man. His face conveyed a lot. It was typical of Down’s syndrome. He was propped up with an oxygen mask strapped to his face. He was covered with cold sweat, the fluorescent light gleamed off him. His eyes were fixed in a dead stare. All these told me he was in shock, possibly cardiogenic. Putting the stetho there was no heart sound, nor any breath sound. I began CPR and the related procedures of ACLS. Time ticked away, with each press of the chest a little bit of hope passed away. His ribs cracked under pressure, I could feel it in my hands. The breath of death hit me. With every press of the chest froth emanated from his mouth, telling me of pulmonary edema, that he had drowned in his own body fluids, sitting there in his bed. The resuscitation was unsuccessful.

The father was inconsolable. He kept telling, “I did everything I could, why didn’t he get a few more years?”  It is in moments like these you realize the absurdity the world, the absurdity of the molecular gamble that results in having the a young boy an extra chromosome 21, that results in his untimely death. It is in moments like these you question your faith, perhaps even loose them.

Why be decent?

“From my grandfather Verus: decency and a mild temper.” –Meditations, Book 1, 1. Marcus Aurelius.

 

Why be decent? Is it because it’s the right thing to do, or is it to merely facilitate the everyday interactions between us evolved talking apes, to keep the diverse cogs and gears of the society well greased so that it keeps functioning without any disruption? In unfeeling, logical world, a world solely inhabited by mechanical beings perhaps decency would be redundant. But before delving in to the question of why be decent, I must have a clear idea about what it is to be decent. Not to make anyone ill at ease with behavior words or actions will serve my purpose sufficiently for the present discourse although by no means this is a robust definition as I shall shortly demonstrate. The above definition however, begs the question as to how anyone should know what it is that put others ill at ease. If we assume every person to be different then can we not assume every one has a different set of conditions that makes them ill at ease. Or does the human condition has one basic set of conditions/actions that puts the majority if not all of humanity ill at ease. If that be the case,then it becomes easier for some one trying to decide how to be decent, for it involves figuring out the conditions that makes oneself ill at ease. Then being a part of the humanity, he can be sure that a large subset of those conditions is common to the rest of the humanity. Thus he gets a solution to the problem of how to be decent, that is, he has to merely follow the rule. “One should treat others as one would like others to treat oneself.”  

 

But alas, if the universe was only that simple. What if the set of conditions that makes Mr. X uncomfortable is not in common with the rest of the humanity? Consider Mr. X to be a masochist. Being subjected to pain makes him at ease. Will he be right to assume that the rest of the humanity will be at ease when inflicted with pain? Your answer may be no, it is only an abnormality but the only abnormality here is the normality of the prevailing majority. If the majority of humanity derived pleasure from pain then wouldn’t it be termed abnormal tonot derive pleasure from pain? As the saying goes, when in Rome do as the Romans do. The proposition of how to be decent can be reframed thusly, not to make the majority of the humanity ill at ease by one’s behavior,words or actions. Not very satisfying is it? What of those minorities whose tastes might differ? Tough luck for them. Or we might search for some objective definition of being decent. Now that is a hard thing to do. Even we are able to answer it, the question remains why be decent?

 

What do we hope to achieve by being decent, by making others at ease? It certainly facilitates our everyday interactions. Is it only that,no other higher purpose? What if a person is indecent? We can reasonably assume that society will shun him. Taken to its extreme of being indecent, that adopting a behavior that is not in concordance with the prevailing social norms leads to isolation from the society. May be it is an evolutionarily acquired trait. We act in conformity to the prevailing social norms to be accepted in to the society so that we might benefit from all that the society offers. Down to its bare bones it is nothing but food, shelter and a mate. These are but the means of propagating out gene pool. Does it have to be such banal? Doesn’t our being decent have to have a higher calling and not just the primitive impulse of propagating our genes? We may delude ourselves to think that we do, that we are decent because it is the right thing to do but it is just tiny bits of DNA pulling our strings behind the screen. Decency is a social construct, subject to variation over time. Some years back, not to long on evolutionary time scale, it was considered indecent for women to come out to work. Indeed much of what women wear today would have been deemed indecent. So much for decency then. If you do not agree with me then go ahead, try being indecent. See what that gets you.If you have risen above the impulse of propagating your gene then it wouldn’t matter to you one way or either.

 

Thus in answering the question why be decent, we come to the conclusion that we are decent because it suits us. So the next time you see some one decent, remember why he is decent no mater what he might claim. Only the truly indecent among us has risen above the impulse of propagating his gene for which he needs to be feted.

Surveying the Ads: of lesbians, watches and Kellogg’s

A. Fast track – The closet Ad

 

The premise – the ad begins by showing a pink closet with a yellow telephone in front. Then we see that the closet is shaking. Immediately following that, two girls come out of the closet arranging their dresses. One looks at the time in her watch and then they look at each other and depart in their separate ways.

It is interesting to note that how the ad uses the theme of lesbianism to attract the viewer’s attention and the underlying hypocrisy of the whole endeavor. The catchline is “Come out of the Closet” yet we see when the girls are out of the closet, they went their separate without acknowledging what went on inside. Well that’s not what coming out of the closet means – if you are not brave to accept what you are then perhaps you are not ready to come out of the closet yet.

Take note of the way the two girls are portrayed – real life lesbians don’t look like that, they look like this –

First married lesbian couple in Argentina

This ad portrays the involved women from the stereotypical male perspective – they both look good, they are dolled up under layers of make up, they are dressed in revealing outfits – all pandering to the male gaze and male fantasy. Note the colors the girls are wearing – one is wearing black signifying masculinity and the other pink indicating feminity, this helps the male viewers to project themselves into the situation. The implied meaning being – we don’t care what you do in the closet, but it should be between along the lines which we can delineate like  masculinity and feminity and it should stay within the closet even if we preach otherwise. Remind me again, why this is at all related to a watch? All I remember are the girls and the shaking closet and my imagination running wild but then again I am just a shallow little pervert.

B. The Kellogg’s 2 weeks challenge Ad

The premise – the ad is narrated by a husband about her wife – how she was shy about dancing as she had gained weight. Then she undertook the Kellogg’s 2 weeks challenge and lost weight and is now dancing away confidently.

This advert is wrong on so many levels that I can’t even begin to comment. My precious, if you are afraid to dance because you have gained a little weight then your problem is not in the weight, it is else where – Kellogg won’t help you but may be shrink can. The fact she is afraid to dance means that she is constant need of other’s approval, she cares about the opinion of the others more than what she wants do – and it is for such a trivial matter as dancing in a wedding. Think about her need of approval regarding the big decisions of her life. I wonder how far would she have gone to win the approval of others – may be liposuction? May be other crash diets? Strangely her husband goes along with her in this. It has been said don’t judge a book by its cover, but now not only others judge the book by its cover but the book judges itself based on its cover and feels bad about it and no I haven’t got this backwards.

May be this is what has as afflicted our society as a whole – we are too wound up in trivialities to care for things those really matter. The search for quick fix solutions drive us insane a little by little – in our cooped up holes of idiocy we forget the laws of thermodynamics, we forget that unless we burn the energy that we take in we are never going to lose weight. But do I expect too much from the society – how many of us remember what the laws of thermodynamics were?

Yes, you are a slacktivist

Digital activism, not the kind pursued by Wikileaks or Anonymous or the Bradley Mannings of the world, but by the call center working, McDonald’s eating, multiplex hopping rest of us epitomized by liking, sharing and commenting on Facebook is arguably the worst form of hypocrisy that has afflicted humanity in the last few years. I was driven in to this rambling by this piece – ‘Dry Holi’ Campaign: Is Digital Activism Slacktivism? in which the author tries to defend the kind of digital activism described above, or digital slacktivism if you so prefer, by ironically resorting to slacktivity itself. His arguments are so poorly constructed that you can’t help but sneer. Consider this gem of a paragraph

“I disagree. Participants in digital activism are mostly students and young professionals. If they did not have an outlet like social media, what other options would they have? Rallies, protest marches, hunger strikes, public gatherings or distributing pamphlets on the railway platforms? How many of the participants could give either their time or efforts for such activities, balancing college or workplace commitments? Is it fair to expect them to become full-fledged activists? Social activists have their own commitments and resources and they are fighting their own battles somewhere else. But does that mean, we, normal citizens can’t play any role in changing our society?”

What’s wrong with rallies, protest marches, hunger strikes, public gatherings or distributing pamphlets aside from the fact of actually making you commit to a cause, aside from making you have a personal stake in it? If you think your college or work commitments are more important then stop being dishonest and stop pretending to be an activist because you are not. And what on earth means “A full fledged activist”? Are they a different species from humans than us, the normal citizens? This is the main problem with digital slacktivists, they tend to think of down and dirty activism as something different than what they do, something they can not imagine themselves to be a part of hence they are contended with liking pages in Facebook though they feel the need to defend their actions. Consider this, if Netaji Subhash Chandra Bose hadn’t left the ICS or Gandhiji had continued as a barrister because they needed to maintain the balance in their workplace. Well the joke’s on you. We should be man enough to own up that we don’t have the guts to be an activist but we like the charms associated with being labeled one, the mystique of being called a well informed, social conscious citizen and we get that high by liking the Anti Rape page while searching for porn in the next tab.

This digital activism that we practice helps us to feel good, makes us feel important, imbibes us with a sense of accomplishment, calms our righteous indignation without actually doing any work. Do you think that the next person raping a girl gives two hoots about you liking the “Respect Women” page? The only gratification that you obtain is for you only, quite like masturbation. You want to be called a digital activist because you want to look like someone who cares without actually taking up any responsibilities. Because taking up responsibilities have consequences. And we are too comfortable sitting in our chairs, with a soda in hand, with our unlimited broadband connection to face any consequence. We may delude ourselves into thinking that we care but we don’t, we just love ourselves too much to trick us in to thinking that we care. We don’t want to be left behind, hence we jump in to the bandwagon though our very actions may indicate otherwise.

Think about “The Matrix” trilogy. The machines allowed the humans to have their revolution, albeit in the very way the machines wanted. The cycle continued with the humans thinking that are revolting and the machines chuckling to themselves. The social media gives you such an opportunity – to revolt against perceived injustices, to vent your indignation without having an effect in reality.

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You think you are empowered?

While idling away in Facebook, I came across a short excerpt purportedly written by Sudha Murthy, who was described as an Author, Philanthropist and Chair person- Infosys Foundation (that great hope and aspiration of the educated, urban Indian), who, incidentally is also the wife of N.R. Narayana Murthy. The piece was designed to be an uplifting tale of a young woman’s journey against (perceived) adversity (patriarchy, to be precise), presumably as a parable to other women, perhaps exhorting them to follow in her footsteps.

The cynic in me smiled inwardly. Does she realize that in her righteous rebellion against patriarchy she herself has become a tool to perpetuate it? Let us examine what she says we would decide for ourselves what exactly is going on. The first question that we should ponder on is why did she decide to give up on an academic career and take up a job in that bastion of patriarchy that was TELCO? Was it because they paid better? Was it because of the flexible working hours? Was it because of the job security? No, it was none of these reasons. It was because of the prohibition they imposed, because of the sense of power they exuded by this prohibition. It was closed down affair, atleast from the perspective of women and she wanted in even if she had to ape men in doing so. The shopfloor in this case represented the holy grail to her, from where patriarchy supposedly derived it’s power. Note that the job itself was not desirable to her, it was desirable only because of the prohibited power that it represented in her psyche. Thus the system gained a willing drone, who willingly took a job that she otherwise wouldn’t have taken up, who wouldn’t question the working hours, who wouldn’t question the pay, because she had to live upto the expectation of being the first woman on the shopfloor, because she was more concerned with the illusion of power that came with being the first woman on the shopfloor. And the system loved it. See how patriarchy gets hold of your feminism and turns it upside down while you still wallow in the glory of having successfully revolted against it.
If you have a cynic’s eye you will notice how she waxes on eloquently about JRD Tata. This is actually a trap. Follow the story carefully, how she got the call for the interview only after writing to JRD Tata. JRD Tata assumes the role of the benevolent paternal figure who is always there to lookout for you. And there she is always trying to win his approval. JRD Tata becomes larger than the system and you never suspect how insidiously patriarchy manipulated her, how it was there to wait for when she was going home from work in the form of JRD and her husband, how it was there to guide her and wish her when she left TELCO.

So when you think you have rebelled against patriarchy, think again. Your rebellion is exactly what the system wanted because it suits its own end. If you are still not convinced, let me show one last trick up its sleeve. You may have read the excerpt written by Sudha Murthy thinking to yourself that you are reading the story of an empowered woman but that’s not why you really read it, did you? I know it and you know it too however vehemently you may deny it. You read it because it is the story of Sudha Murthy, Author, Philanthropist, Chairperson of Infosys Foundation and wife of N.R. Narayana Murthy.

Violence against women and Bollywood

The recent incident of gang rape in Delhi gives us the opportunity to introspect about the portrayal of women in the bollywood movies in recent years. Prof. Amartya Sen in his book “The Argumentative Indian” writes that despite the presence of physical asymmetry between women and men, the possibility of physical violence can actually be used ( to settle a dispute or gain an advantage) only when the permissibility of such behavior is accepted explicitly or by implication. I would argue that the portrayal of women in the bollywood movies grants such permission by allowing and encouraging the sexual objectification of women.

 

An example

If we examine the representation of women in bollywood movies, even the mainstream movies, leave alone the B grade movies, we can observe that there has been a gradual legitimization of sexual objectification of women. The concept of “item number” is a testament to this. The pervasive use of item number in the movies encourages, even celebrates, the basest of our instincts over and above our reason. Can there be anything more degrading to a woman than being labeled and item? Yet we find our heroines gloating over their performance in an item song! The argument of the widespread prevalence of “item songs” that it is what the market demands is a specious one and doesn’t merit a comprehensive rebuttal. Suffice to say that following this logic, porn should be the only form of cinema.

 

We have or Munnis and Sheila and Chikni Chamelis and scores of lascivious looking men salivating around them. This leads to a ccognitive disconnect. The legitimization of what would have been deemed inappropriate activity and the favorable response of the women concerned towards such inappropriate activity in the fictional world of the movies creates an expectation of the same happening in the real world, but when reality does not conform to one’s perception of reality as molded by the movies, one resorts to violence, rape etc. The cognitive disconnect arises from the fact that what is portrayed as acceptable behavior in a movie is not acceptable in actuality.

 

Changes

In the next few days I will be migrating the blog from blogger to wordpress.