Published Manuscript: Burnout and Sleep Quality

I had worked on a project that explored the association between sleep quality and burnout in Indian undergraduate students. I presented the results in the summer of 2014 at ISCOMS - Netherlands. And it's finally been published in a PubMED indexed journal - Cureus. It's been a long and largely self-taught road to publication. But none of it would have happened without the support of the people I work with in college.

Link to the article

 

Weekly review: Neuroscience

"Virtually all of the body's organs and functions are regulated through circuits of neurons communicating through electrochemical impulses. The theory is that if you can accurately map the neural signatures of certain diseases, you could then stimulate or inhibit the malfunctioning pathways with tiny electrodes in order to restore health, without having to flood the system with molecular medicines."

It's been a while since this article came out, yet even as I re-read this today after all the knowledge I might have gained over the past few years, this idea of a neurally integrated immune system, is as staggering a concept as it was when I first read about it two years ago. 

The classical approach to immunological diseases, is that a fundamental genetic flaw prevents your body's immune system from differentiating between its own cells, and that of a foreign agent. It's friendly fire at a cellular level. Recent work on the body's neural circuits however show that stimulating or inhibiting specific neural pathways can greatly alter the progression of diseases that were, till now, thought to have a purely immune mediated pathogenesis. Diseases like Rheumatoid Arthritis and Multiple Sclerosis have the potential to be treated not by drugs, but by targeted stimulation of nerves. 

It's all very fascinating work, and I highly recommend that you have a read if you're an engineer or a student of the biomedical sciences. Once you're done with that, have a look at these brilliant paintings by Dr. Greg Dunn - a man who through his art, hopes to give voice to scientists whose work usually isn't appreciated by the general public.

Finals week

I haven't done anything creative for a long, long time now. I can feel it gnawing away at the back of my mind. I used to think that being creative is a way for me to relax and escape the daily grind, but now I feel it's a much more integral part of who I am. The surge of chemicals that fire off in the brain every time you publish your work for the world to see, that feeling pure of unbridled accomplishment: it is addictive. Whether in Art, literature, or medicine - creating is living. 

My Story: Chapter 1

My name is Rohan Shad Arora. Shad itself is a persian word, a name that stuck on to my grandfather while he fled Pakistan for India during the 1947 partition. I use it as my surname rather than my middle name because well, I like it more. I am of mixed punjabi - nepalese descent. I don't have what you would call a 'cultural heritage'. I fit in; yet kind of stick out in many ways. I have grown up across 3 countries and 'home' is a concept that I find hard to quantify; for the sake of convenience I say it's New Delhi, but it's slightly more complicated than that.

I was born in Harefield, which is a small town, North-West of London. Harefield is quite famous in the world of medicine, known for the pioneering techniques of heart surgery developed at Harefield hospital. My first few years in England are a bit of a blur, I obviously don't remember much apart from vague memories of watching Superman on the TV, or playing with sand in playschool. I spent 3 years in and around the area, before my family decided to shift to Kathmandu, Nepal.

My parents made this bold and seemingly illogical move, for want of a simpler life, closer to what they called 'home'.  My mother, a radiologist did quite well there. My dad was one of the only cardiac surgeons in the area at that time; and as young and relatively inexperienced as he was, he did a world of good to a lot of people. Dad of course had to learn Nepalese from scratch, a mammoth task for a thoroughbred Punjabi.

I remember these years fondly. I watched my parents buy an estate perched on a 40 foot mini-cliff, and I remember playing in the foundations of what was to become our home. Months went by, and from the rubble grew a wonderful place to live. My parents, both coming from impoverished backgrounds, were proud of what they had achieved. Those years were some of the best we had as a family. My mum's side of the family all lived in Nepal, and it was quite cool to grow up with all my cousins.

Ofcourse, things changed just as we began to feel settled. It was the year 2001, and my parents were doing pretty well. I was in my 3rd grade at the time. News broke out that the royal family of Nepal had just been massacred; and slowly but steadily, the mountainous paradise that was Kathmandu, fell into chaos. Maoist rebels, civil unrest - the whole shebang. My parents for whatever reason, felt that the country was getting unsafe and better opportunities were to be found elsewhere; and after 4 blissful years in Nepal, we left everything behind for England. 

Back to London, this time in Ickenham. Ickenham is actually quite close to Harefield, so it did feel like home in a strange way. Ofcourse leaving behind the house in Kathmandu was not fun at all, but you get used to things like that surprisingly fast. The professional transition for my parents, was an abrupt and jarring one. So no surprises there that it took them a while to get back on their feet.

As always, over time things improved, and I felt quite settled there to be honest. I was doing fine in primary school, and was all set to join Langley Grammar (secondary school). My parents didn't meld into the British way of life as completely as I had. They did miss things about India from time to time, and I think that was partly a conscious effort to preserve their cultural identity. It's quite amazing how Indian people behave more 'Indian' abroad, than they do in India. Thankfully my parents didn't completely isolate themselves; they had friends, we went for barbecues and christmas dinners and what not.

We spent around 4 years in Ickenham, when all of a sudden my parents told me we're going to India. I threw a crazy fit: "But we won't have Uxbridge there!!" "India doesn't even have a tube or motorways!!" "I don't want to go to smelly India!!"...

Despite my earnest attempts to convince my parents otherwise, we landed in Kolkata in 2005 (or Calcutta before the Bengalis threw their own fit and renamed it to sound silly). 

To be continued...

Prime Fifty

A prime fifty in photography speak is a 50mm fixed lens. In contrast to the zoom lenses that have variable focal lengths (18-55mm or 70-300mm), a prime lens is fixed at 50mm. Which of course means you can't zoom in. I've started feeling a little restricted after owning and using the 18-55mm kit lens that came with my SLR. Sure its a versatile piece of kit; with a broad spread of focal lengths from 18mm to 55mm you can shoot natural landscapes and close up portraits with equal flair. 

The limitations I'm talking about hit you later as you keep using the damned thing. For example, I've noticed how restricted I am when it comes to low-light photography with the kit lens, or the fact that I routinely feel the need to increase the sharpness of images because the lens just didn't capture enough detail.

The 50mm prime lens by design, has fewer moving parts and a simpler structure. The lens glass is of an extremely high quality, and it can shoot at much wider apertures (ie. It shoots way better in low light). Because of the wide aperture, you get that silky blur in the background of your images too - I really like that. On top of all that, 50mm lenses are really cheap. I bought mine on a 40% discount at around Rs 9000/-. 

DSC_0474-4.jpg

I'm pretty pleased with the quality of the images so far. The lack of zoom means I have to pay more attention to framing a decent shot, but I guess I'll get used to it. 

Life Bitesized : Vol 1

Before I begin, I know I haven't written for well over a month now; my apologies. 

The past few posts have been quite heavy, laden with vitriolic and polarising political statements. Quite frankly, I'm a little tired of writing about the politics of national healthcare.  I'm trying to frame a writing schedule that works for me. I've realised can't churn out long posts every week, so maybe a long post every 6 weeks and a few smaller ones in between should do? 

Anyway, with my girlfriend in town and my college fest round the corner (which by the way, will be terrible this year), I have for all practical purposes stopped studying. It's funny how not reading up regularly makes everything in medicine feel so alien, but I honestly couldn't care less right now. I need to live a life, and spending my nights with microbiology isn't something I'm too keen on doing right now. 

It was New Years Eve when I realised I wasn't very happy with where I was taking my life. I was spending too much time on things I didn't like doing, working non-stop toward building a resumé. I took up projects I didn't have any interest in, I went to conferences I had no business attending. I felt overworked and taxed, and I was hating it all. I decided to stop wasting my time with that juvenile nonsense, and henceforth only did things I genuinely liked doing. It led me to write more, read more and draw more, all while maintaing a decent level of proficiency with my course work. This 'New Years resolution' has given me quite the sense of fulfilment these past months. It's unfortunately been the only silver lining for an otherwise overcast and drab time.

Looking back at the past year and a half, I can say that the social side of medical school has been a complete disappointment. It really could have been amazing, but it isn't. It's mostly a mind numbing exercise, and I find myself enjoying the hours after class that I spend in the reading room, more than the college hours itself. It's also impossible to strike a meaningful conversation here that doesn't end in a) a fight or b) people sulking around because you've inadvertently hurt their sentiments. It's a real bore, and I wish more of my friends smoked weed or drank themselves silly. There are highs in college; last years fest was pretty cool, and the recent trip to Udaipur was properly fun. But then again, everyone fought after Udaipur happened, and that kind of ruined the entire thing. I've never understood these petty fights. I like to stay out of them, but it's boring watching other people bicker after a while.

Anyway, I'm going to cut this post short and end what would have inevitably become another long vitriolic rant. You'll thank me later. The title if you're wondering, doesn't mean anything at all. It just gives me room to write a Vol 2 which might actually be worth reading.

Seven and a half

A few weeks ago, I had written at length about some of the biggest healthcare challenges we face as a nation; everything from private healthcare costs, the quirky medical education system, and the faltering standards of government health services. It's now election season here in India, and the government has found itself rushing to pass some last minute laws. 

One of these laws talks about the compulsory rural posting, an issue that I had touched on in that article. The rural posting requirement is basically a one year long compulsory stint, at a small public health care facility. The purpose of it all is to ensure citizens in far flung corners of the country, receive a minimal, but at many times life saving amount of healthcare. 

The government will on the 28th of this month, pass the rural posting law into effect. An unexpected addendum to this proposal however, was an increase in the internship duration from 1 year to 2 years. To see the government disregard us to the extent that it didn't even think it was necessary to formally announce it, is disheartening to say the least. Anyway, in a matter of less than a fortnight, medical students around the country would have come to the stunning realisation, that their  5.5 year courses are now to be extended to a total of 7.5 years.

Let's think about that for a moment. In 7.5 years, one can graduate from Delhi University with a bachelors degree, finish an MBA, and get a year and a halves worth of fruitful employment. 

Medicine is a long drawn battle, it's not something you just do overnight; we all knew that. We're all pretty much prepared to work our twenties away in the service of the sick, then slave off our thirties as an apprentice of a higher consultant. For all practical purposes, you'll be around 40 years of age before you really make a name for yourself in this business.

It's too early at the moment, for strikes and protests to be organised - not that they've ever helped much. And to be honest, I don't even know if this is a good thing or not. I mean, how bad can it really be? 

Update:

Long story short, we're back at 5.5 years because of protests + the government is too lazy to implement the 7.5 year plan yet. Yay?

Maybe next week

I had planned to write something this weekend, but apart from crashing my car a few days ago, I've also come down with a rather painful bout of amoebiasis - atleast everyone thinks that's what I've contracted anyway.

What a shit week.

I'll try and have something written up for the blog next weekend at the earliest. 

 

The Ailing Nation

India is a country that is not very well known for its medical advancements. We rank 136th in the Human Development Index, 77th in quality of life, and 168th according to Literacy rate. We rank 16th in the list of countries worst affected by hunger and food crises. As a nation, we filed just over 15,000 patents in the year 2011. In comparison, China filed over 435,000 and Japan over 472,000.

Only a small fraction of the country’s population can afford the kind of healthcare that my father provides in a private hospital. His department is staffed by diligent nurses and affable doctors, most with some foreign training. The machines are state of the art - just the handles of certain surgical blades can cost lakhs, and that is excluding the fancy gamma knives and ultrasonic tissue knives that they routinely use. The quality of healthcare and investment in infrastructure in these hospitals, are second to none. 

Despite the charity, and despite the discounts given by doctors for poorer patients, private healthcare is strictly for the well heeled. 96.9% of Indians - 96.9% - live on less than Rs 9000 a month. An ICU bed can rack up a bill of Rs 25,000/- per day, a heart operation can cost anything between Rs 1,50,000 to Rs 10,00,000. It isn't surprising therefore, that most of the country finds it’s way into government hospitals. A safe haven if you will, for those without deep pockets. 

In stark contrast to the private hospitals, government hospitals here are burgeoning, decadent institutions, overflowing with the diseased and the sick. Beset by a scarcity of funding, poor infrastructure, and an almost inhuman patient load, it's a mystery how these hospitals function. If nothing, these hospitals are a shining example of Indian ingenuity at it's finest: Making things work - sometimes barely - with absolutely nothing at hand. The ever ubiquitous 'jugaad'.

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Next Project: Jaguar F-type

In 1961, Jaguar motors launched the bewitchingly beautiful E-Type. It was a lithe masterpiece, from what many consider to be the golden age of automotive history. It had a 3.8 litre inline six for an engine, mated to a 4-speed manual gearbox. The 260 horses hidden within it's six cylinders, meant that an E-type could outrun a  Ferrari that was twice it's price. Steve McQueen had one, and so does Richard Hammond. The design of the thing was so influential, so right in every conceivable way, that it was added to the permanent design collection of the New York Museum of Modern Art. Even Enzo Ferrari at the time, admitted it was "the most beautiful car in the world". After a record 70,000 units sold, the E-type was phased out later in 1974 amidst increasingly difficult financial times for the Jaguar auto company.

1961 Jaguar E-type © Chris Bull

1961 Jaguar E-type © Chris Bull

Ford motors bought the Jaguar motor company in the late 1980's, and brought with them some much needed cash - which was good. They unfortunately brought with them, their design sensibilities aswell, which meant cars like the E-type were replaced by strange archaic boxes based on Ford sedans. 

In 2008, Tata motors bought Jaguar from Ford, and ever since, the company has produced some of the best looking cars out there. The new XJ and XF sedans are master crafted cars, harking back to the subtlety of the 1960's with their sleek fluidic body panels, and ever omnipresent V8 crackles and burbles. Yet there was no E-type replacement to be seen.

Jaguar F-type convertible and coupé © CarbonOctane

Jaguar F-type convertible and coupé © CarbonOctane

All that changed with the 2012 Paris Motor show, where Jaguar showcased it's brand new F-type convertible. The F-type coupé that launched later in 2013, is as close a successor of the E-type the world will ever get. It comes with a 375 bhp 3.0 litre V6 - or a bonkers 542 bhp 5.0 litre V8. It makes the right sounds, and is probably the most stunning car of 2013. It's not the fastest car in the world, or the most expensive - then again, neither was the E-type in it's day. The E-type was in a league of its own, nothing even came close to it; the F-type today competes with the likes of the Porsche Cayman S and Aston Martin V8 Vantage. Those are some fancy names, but the F-type is art on wheels; just as the E-type was. 

I hope start drawing the F-type soon, and maybe this time I'll experiment with some colour (for the brake callipers and taillights). Till then, make sure you visit the portfolio and check out the one's I've done so far.

Pointing Skyward

This is one of those drawings that starts off really well, but then drags on forever and ever. I started this one last year, and a hectic work schedule & my insipid laziness meant I took a whole year to do this. I think the drawing time itself would be less than 11 hours, so it's not a particularly difficult one to do, once you have the basic outline correct. 

As mentioned somewhere in the portfolio, drawing skin is a slight challenge because of all the little crease lines and textures. The usual blending technique gives way to more deliberate strokes of a 2H pencil. 

If this then that

I stumbled across this wonderful web-service/app thing called 'if this then that' or 'IFTTT'. What it essentially does, is connect various services like say pocket to tumblr in ways that are otherwise impossible, or require a degree in computer engineering to accomplish. 

For example, you could craft a 'recipe' as they call it, that backs up your iPhone camera roll to your google drive.  Or you could craft one that makes a reminder in your favourite reminders app, whenever you star an email. All of this mind you, in a few simple steps. 

Even better, there's a farrago of existing recipes that you can cherry pick as per your requirements. I've found one that makes a tumblr blog post, out of every article that I favourite in my pocket list; so far it's working great. Another one that I use right now, makes a spreadsheet out of every email I receive with 'order' or 'receipt' in the title. Helps me keep track of the money I blow on iTunes or Flipkart. 

All in all, it's an interesting and simple way to automate tasks. I highly recommend you check it out

Death by Belladonna

 

Atropa belladonna, commonly known as Belladonna or Deadly Nightshade, is a perennial herbaceous plant of the family Solanaceae, native to Europe, North Africa, and Western Asia. The foliage and berries are extremely toxic, containing tropane alkaloids. The drug atropine is derived from this plant. Random right?

In Italian, the word belladonna literally means “beautiful lady”. In the old days in Italy, they used belladonna extracts to dilate the pupils (the black dot at the centre of the coloured ring in your eye) of women, because that’s what - in those days - was considered beautiful. Prolonged usage caused blindness, and that probably had something to do with it going out of fashion.

Belladonna was also used for letters. If in the 18th or whatever century it was, you wanted to send a written letter by hand, but needed to make sure it was kept a secret, you had a little problem. You could either trust that your messenger won’t open it; or you could lace the letter with extract of belladonna.

The moment the messenger lays his eyes on the belladonna laced letter, his pupils would dilate because of its fumes. The normal reflex of the human eyes is to constrict the pupils in response to excess light (ie. a lit lantern). If this does not happen, the recepient would know that the letter has been read, and the promised privacy has been compromised.

If the treacherous messenger hadn't kept to his word, he would soon find that on delivering the precious letter to the correct address, he would be greeted by a bright lantern to light his face. The recipient would take the letter from his hand, fold it in his pocket; and in exeunt, slash his throat before fading into the darkness.

The other day, dad was telling me about a case he was treating in the early years of his training. He was a junior resident then. They had just finished operating on a woman, but she had lost so much blood that she went into severe hypotension. Hypotension is basically low blood pressure. The reason why blood pressure is so important, is because without it, the brain wont get enough blood, and consequently the patient can die. So despite huge doses of norepinephrine and atropine, the patient still lay still. 

The way it works is that after a long period of low blood supply to the brain, parts of it necessary for human survival can die. While you may still be able to keep the patients heart rate, respiratory rate etc up to normal levels by artifical means; the patient herself is already dead, and nothing more can be done. There is no brain activity, and no reflex response. Thats brain death for you in simple, non-legal terms.

So the doctors frantically asked her to respond to their commands “wink if you can hear us” “Show us your tongue”. No response. They The doctors then looked at her pupils and shone bright light into them; they were both wide open. No light reflex. They all agreed that the patient is brain dead It was upto my dad to inform the relatives of the bad news. He told her nephew in as calm a voice as he could “She’s already gone, her heart is beating but her brain has died.” 

The nephew was broken; the family cried for an hour, and cursed the hospital for another. Until finally, the newpew came to her bedside and slowly wept in his native tounge “Please blink”…

The patient blinked.

The doctors swerved back, and huddled around her bed. They looked at each other in disbelief. How could doctors, all trained in the hallowed grounds of the All India Institude of Medical Sciences, possibly declare a patient brain dead when she was alive and well? The problem was almost comical… 

We all know the effects of belladonna on the eyes of women; and since Atropine is derived from the same plant, all you need to do is connect the dots.

For those who care: Atropine blocks the Acetylcholine receptors in the myocardium, thus reducing parasympathetic stimulation via the Vagus nerve. The decreased parasympathetic stimulation is what causes an increased heart rate. Thats why it’s used in conjunction with norepinephrine and epinephrine to manage hypovolaemic shock.

Anyway, back to the story. First off, the patient did not understand hindi or english, so she didn’t know what the doctors wanted from her when they asked her to do something. And secondly, because of the high doses of atropine she had been given, her pupils remained dilated. Brain death is a complex and highly debated condition even today, let alone 25 years ago. Two hallmark criteria for braindeath are: lack of auditory and motor responses, and lack of pupil light reflex. Death by belladonna they said, and the rest is history…

In summary, dearest readers, always remember the Atropine. And always remember to keep exploring the world around you. You never know which random piece of information might just save someone’s aunt.