"it takes a lot of gut to follow your heart"

I have heard that before.

She was frail,recovering from a heart attack.She looked comfortable and her expressions were like a smiling face.She got married thrice,and always found a new love,she revealed herself.

She was on a roll that day as she continued,our heart speak a simple language from day one of our being in this world.That language never change but we grow up as we believe and start giving meanings to our heart's straight talk.

We never like straight answers especially if those come from our heart,she kept talking to me.That is the cause of all unhappiness and depression.

She gave me something to contemplate that day onwards.

To some matters of heart are beyond common sense and laws of probability.

Others dive in deep to have lines of communication with their own heart.They are the authors of ultimate love stories by following their heart. Those are the people who are guided through life's cake and chaos,like a marriage vow: in health and sickness be there as one.

"building a castle on soft sand"

I spoke with her family,she was not getting better.They were accepting the fact that their mom will die at some point in her hospital stay.

In the coming days she started to show some signs of stability but her prognosis remain poor.Her kidneys were failing with minimal output,lungs were venting on borrowed breaths.Though she appeared comfortable and lively.

The same family who once accepted the fact of life then start building a castle on soft sand.I saw a yawning of hope in the march of death.

This is life we all struggle to live,I heard from a colleague.

To some it is easy to see what is so obviously there and coming,that's the job of professionals.

Others who watch a slow death of a loved one live and die daily while waiting for the ultimate to flatten their castle on soft sand.

“many are called, but few are chosen”

I stopped reading the article until I read this "Many are called, but few are chosen.” I wondered,may be how it worked then and every day now.

He was admitted to hospital with a range of medical issues.Those conditions of encephalopathy,hypoxia and failure to thrive lead to final discussion with his family to decide as he would have wished in a situation like that.The decision was made for comfort measures only with withdrawal of medications not fit for the goal of passing away in peace with dignity:no pain,no suffering.

He got very comfortable,so much so that his survival day after day lead the most interesting question asked by his family,why he was not dying?

I answered them,he is a fighter.

Today as I was reading this "Many are called, but few are chosen",I got my answer.

"to step on magic carpet with anticipation"

Sometimes I struggle between what I want and what I get.I guess we all do struggle this way all our lives.

The other day there was a case of a young woman with a neuromuscular disease that had progressed to respiratory failure and dependence on ventilator.I wanted her to get better,come off ventilator,eat as she used to a few months ago.I was wishful and I had struggles.My conflict of mind and heart knocking on doors of my soul.I asked for be guided and I was lead to do my best.

Another case of an older man with end stage emphysema on high flow oxygen depriving him from eating,sleeping,talking.He was afraid of dying as if he ever fall asleep.He appeared to me like a warrior dying of his own fear of enemy.I wanted him to come out of his fear and breath life.I was wishful and I had struggles,conflict of mind and heart knocking on doors of my soul.I asked for be guided and I was lead to do my best.

We all do have our magic movements in our lives,you may see in the eyes of a lover or in the heart of a seeker.The mystery of universe revolves only if we keep asking and searching,the mystery resolve once we become part of it.

To some magic carpet and magic moments happen only in stories.
To others,magic happen on demand,they only have to do is to step on magic carpet with anticipation,"ask and you shall receive".

So I stood on my prayer rug then knelled and bowed my head asking for guidance in anticipation,"ask and you shall receive".

"walking in a temple,living in a prayer"

He was a physician,I met him after his admission for respiratory failure due to a progressive neuromuscular disease.He told me that he was a good one and he had diagnosed his own disease at least five years prior to his physician had diagnosed.
There was no treatment so he remained quite and kept his secret until now.

He was the most understanding patient I have ever met,he told me that he was not afraid of dying.He continued by saying that all his life he served his patient with humility,knowing that medicine has cure for a few diseases and most of time it is symptom management.He believed in honouring human life,the most sacred human attribute as a physician.

The other day when his condition got too unstable,I saw waves after waves of people visiting him.I came to know those people were his patients of all those years when he was walking in a temple,living in a prayer,his calling as a physician.

"a fallen Christmas tree on a side walk"

We are almost there, Thanksgiving is coming soon and then the festive commercial holiday season of Christmas. I was talking to him about future, hope and living for another day to have one more day to live..

He was depressed as being the youngest in his family of six siblings, he was the only one alive. He was well accomplished in his life and now at the cross road of time, he was alone. He told me,he never found time to get marry and have a family. His life was always on the go to end up like this, he said with sadness.

Then he asked me, have I ever seen a Christmas tree after Christmas day on a side walk to be picked up. People discard those festive trees after giving life with decorative ornaments,lights and laughs. He told me that he felt like that tree on the side walk of life.

He died in the winter of that year surrounded by his doctor and nurses.

As another Christmas season is in air it will remind me about him when I will see a fallen Christmas tree on a side walk.

But I also want to remember that when trees surrender leaves in winter,they regain it in spring,that is the cycle of life.

"life offer choices and chances"

He was admitted after suffering a heart attack then having a pneumonia.While he was recovering from a failing heart,he told me that his wife died after a protracted illness while he was in hospital.He regretted that he was not there when she had her last services.I saw tears in his eyes as he showed me his broken heart.

He was talking about his love,how he missed her,why that happened to him.He cried for his unsaid goodbyes.

He said,If only if he had a choice,he had taken that.But he had none as he was told then that his chance of surviving that heart attack was dismal.

Now he was alive,recovering and soon to be discharged home.

Life offer choices and chances in its majestic scheme of events.Lucky are those who have choices in life.Some may say that luck is a matter of chance not ones choice.

To some his survival from a massive heart attack was a celebration of luck,a matter of chance in hundreds.To others,his life here after will be a matter of choice he has to make,an opportunity he got by chance.

a patient care agenda: an organic solution

I have learned from holistic care gurus that organic foods and natural cures have no side effects.It sound like a cliche as nature has its own way of doing things, effects which we may not understand and probably not call as side effects as the effects may be rather not so dramatic or upfront.

Recently attending a primary care innovations conference from a leading medical school,it dawn upon me that as a physician group we are either too smart or no-so-smart. I wonder as we are being pushed to become administrators by using business models in our patient care.

Are we missing something really basic in our delivery of health care.This is the question, how to keep patient care simple?

The speakers with very effective power point presentations were conveying data.I saw spaghetti models,fish bone graphs and a slew of informative slides. The words of wisdom were focused on improving health care.It sounded like I can hear the foot steps of a reformed coordinated care model at our door steps.The idea of involvement of teams from office receptionists to physician assistants,nurse practitioners,social workers and physicians is simply wonderful.Another idea of patients being followed by phone calls,power of electronic medical records and creating a dialog among multidisciplinary teams is super wonderful.The one thing was beyond my understanding was that where were the patients as it was so focused on them with savings cost.

As patients focused care models being developed I think physicians are more and more pushed into a management model rather than a workable, passionate and compassionate model.I did go to medical school to serve humanity,I love this profession and the responsibility with privilege comes with being called a doctor.I just love it.I remember going to doctors office with my parents in a different part of world without any manged care.I know my parents loved and respected their doctors,I certainly did. I wonder what is so new when we talk about patient focused models, communications, coordinated care and home visits by a physician caring a bag and stethoscope.I have seen all that but what happened in last decade or so that we the physicians and our patients start speaking different languages,we now need to improve our communication.

I heard in the conference,one speaker saying that "patients get confused that why doctors ask so many questions while patient expectation is to get answers".The real challenge is to incorporate patients in their own care.This is going to be challenging as we know patients come from different back grounds,cultures,regions with different myths,expectations and realities.Each individual patient is a story in its own way,which we call as their history; present,past,social,family.

I think engaging patients in their care with developmental tools to enhance broad based partnership between health care and patient is one of the more rewarding and sustaining cost effective solution in our health care reform.One way of doing so lies in our education system by introducing a curriculum like being a patient what to do and what to expect with resources and simplified do's and don't.The value of preventive medicine in our school systems like drug addiction issues to safe sex education already exist.

Our future generation of texters and tweeters are certainly going to be more deprived of humanly face to face contact with a healing touch as our search for a coordinated electronic care is evolving.I certainly did not go to medical school to avoid an eye contact with a patient in my office to pay attention to properly clicking his symptoms on his electronic medical record.Something need to change but we need to keep humanity as our common destiny.

The concept of caring for a patient as a whole probably need to have a second look from a different eye to see and a different mind to vision.It may come from a patient or from a physician as middle man business concepts are taking away the real spirit of our practice of medicine.As we are stepping forward in our search for a patient driven agenda,an organic solution may be in spinning back to past.This may be a road to future success.

"love is too big to fail"

She was twenty five years young with a progressive neuromuscular disease,bed bound on artificial means of survival.I was told she like to watch television.

I saw she was living a life with her eyes staring at the television screen.
I saw dreams of some other day in the eyes of those who loved her and professionals who provided care.

I saw her world was confined with her limitations of body,mind and survival needs.
I also saw expansion of others world in love,compassion and acceptance.

Our lives on the planet earth sometimes take us to distenations of extreme compromise to raise us to the final gates of infinite humanity.The common destiny of us all beyond what we have taught of otherwise.

As I took care of her,I saw her family's involvement in those having similar condition.That was their life mission to stay together as a family to be there as life goes on.

"No questions asked,you can come back to your family anytime as together we stand",I was told.

I saw what I heard before,love is too big to fail.

"wearing nothing but a smile"

Her biggest attribute,according to her family was to wear make up all the times.

She was brought in to hospital with second stroke.Her brain was affected in ways of functioning:communication,perception and control.She was not the same person as she was a week ago.That was the statement by her family.She always wanted to look good.

The days were turning up into weeks.As we were dealing with her on a day to day basis her new attribute appeared as a smiling face.She still looked wonderful wearing nothing but a smile.

After all that happened to her,there she was with a drooling asymmetric face with a smile.

The prognosis was that she will never be the same by the stroke or some may say by the stroke of her luck. She may never need a mirror.

I wondered as whether that was an irony or natures balancing act,by taking away something in pairs and giving back in singles.