Caregiver for a day

“ We need to go to the ER”, said my wife suddenly one afternoon last week.

“Why?” I ask a little befuddled.

“Because this pain in my leg is now excruciating and they say that it could be a blood clot which could lead to a stroke”.

Now you need to know my wife. At four feet something, she is tiny but, as my friends often say, she is “a force of nature” and not to be trifled with. She had always wanted to be a medical doctor but due to her family circumstances, she could not follow her dream, but became an English major instead, and then a very successful editor. However, throughout our married life of about four decades, she has retained her interest in medicine. After my heart attack some five years ago, this almost became an obsession as she read copiously from medical journals, devoured any medical breakthrough reports and subscribed to any number of journals promoting good eating and health. Many a time she would interrupt a conversation with a completely random (at least to us) remark about “ they say you need to cut your carbs” or “ they say that diabetes is a silent killer” or something similar drawn from the latest news from the world of medicine. So much so growing up, our two kids invariably rolled their eyes when she started quoting some medical factoid.” Oh no,” they would cry, “ Not Dr Day again”. You see I had converted her admonitions into a fictitious Dr Day who was always right on medical issues and an Inspector Should, whose commands could not be brooked! It added a lot to her directives that she had rarely been sick or unwell during our four decades together.

So when she announced that we needed to go to the Emergency room (ER) at the nearest hospital, my ears pricked up, as she is normally not an alarmist, at least about her own medical problems. She is rather a procrastinator. I immediately called our family doctor for his advice. My wife described her symptoms in great detail over the phone and was advised that it was unlikely to be anything serious. She, on the other hand, was insistent that it could be a precursor to a blood clot leading to a stroke. Dr Summer then told me that if she needed reassurance she should go to ER and get an ultra sonar test done there. So there we were at the ER at our neighboring hospital, which boasted that it was the best trauma center in the country.

Now the ER, popularized by various TV shows, is a place frantic with activity with doctors and nurses running around in a panic with “code red” or some such thing, working to save a persons life with only seconds to spare. So the calm and silent ER that we found ourselves in was a bit of a shock. There were a dozen or so patients sitting in the room waiting and there was nary a doctor to be seen. There seemed to no sense of urgency there, and I wondered why. Instead, I found that there was a well-developed ritual.

When you first arrive at the ER, (and despite the name to the contrary, the average wait time for emergency room treatment by a doctor is two hours), you will likely undergo some form of triage; a process of determining the order in which, patients are seen. Generally speaking, the highest priority is given to those with the most urgent or life-threatening needs. Emergency rooms do not operate on a first-come, first-served basis. Instead the simple rule is “if it bleeds, it leads.” The triage nurse prioritizes each patient's condition into three general categories: immediately life threatening, urgent, but not immediately life threatening, and less urgent She also gets a brief history of your current medical complaints, past medical problems, medications and allergies so that she can determine the appropriate triage category.

After triage, the next stop is registration - not very exciting and rarely seen on TV. Here they obtain your vital statistics. You have to provide them with your insurance information, Medicare, Medicaid or HMO card. (Although a notice says that the hospital will treat all patients even those without any insurance under the law.) This step is necessary to develop a medical record so that your medical history, lab tests, blood work etc., will all be located on one chart that can be referenced at any time. The bill will also be generated from this information.

The next step is finally the exam room. Here you are seen by an emergency-department nurse who obtains even more detailed information about you. She then gets you settled into a patient gown so that you can be examined. Once she has finished her tasks, the next visitor is an emergency-medicine physician. He gets a more detailed medical history about your present illness, past medical problems, family history, social history, and a complete review of all your body systems. When he has all the information he can obtain, he makes a determination of the most likely diagnosis. Alternately, he may decide that he does not have enough information to make a decision and may require more tests. Or he may decide he needs more advice and so he speaks to a general surgeon. The surgeon comes to see you and performs a thorough review of your history, and your lab data. Depending on a patient's specific medical condition, they will either admit the patient to the hospital, discharge the patient, or transfer the patient to a more appropriate medical facility.

The first ER or specialized trauma care center in the world was opened in 1911 in the United States at the University of Louisville Hospital in Louisville, Kentucky, and was developed by surgeon Arnold Griswold during the 1930s. Griswold also equipped police and fire vehicles with medical supplies and trained officers to give emergency care while en route to the hospital. Today the modern ER performs an important role in the US medical system with over 100 million visitors and an average cost of $1200 per visitor. It really is a marvelous invention that has saved countless lives.

In our case, it took two hours to finish the paperwork and before we were led to the examination room to see a doctor. And it was another two hours before all the tests were completed and she was discharged from the ER. She had an ultra sound test, which was pronounced clear with no signs of any blood clots or possible stroke symptoms. So we came home with a prescription for a painkiller and an admonition to rest her legs. It seemed strange pushing her around in a wheelchair – for the last five years, it was I who was being pushed around by her. Thus began my brief tenure as a caregiver.

Now that I was the caregiver, I had to watch over her. Her concern that the doctors did not know her problem, however, remained. So I kept awake at night to ensure that she did not go into any strange contortions, presaging a possible stroke. Next morning, we decided to consult another doctor- an orthopedist. But he too was sure that it was merely an old injury of the knee and all she needed was rest. The painkillers were now another problem – while they dulled the pain they in turn caused constipation.

I was now in charge of running the household in addition to looking after the lady of the house. I must confess that it was a tiring experience as I shuffled from her bedside to the kitchen and then to the shopping mall. The shopping lists I had, always missed a few essential elements that I found out about only on my return when my wife pointed out that bread without butter would not work. Even as I was moving from the washer to the drier to the microwave, my better half looked on with alternate looks of glee and compassion. I relearned to operate the microwave, the oven, the drier and all these pesky modern machines that clutter up our lives on the pretext of simplifying them. I knew it was time to call it a day when I started dreaming about how to streamline the cleaning and washing and cooking, and started neglecting writing my blogs!

They say you need to walk in another shoes to really develop empathy. Boy, did I develop empathy- loads of it. Of course, she had been doing it for five years. I was ready to give up after five days. But it taught me a lot and I would urge all patients to spend at least a day exchanging places with their caregivers.

The case for Obama

The most cogent and well argued piece on Obama's achievements

http://www.rollingstone.com:80/politics/news/17390/220013

The Delhi Commonwealth Games - the opening ceremonynhy

In case any of you missed the opening ceremony of the delhi Commonwealth games - a spectacular ceremony indeed.

http://www.youtube.com/watch?v=8fLQsW6E7YU

Later, Later …or why we delay things?

There are many ways to avoid things and events in life, but the most sure-fire way just might be procrastination( for a more scholarly article see hers)

Many of us go through life with an array of undone tasks, large and small, nibbling at our conscience. Indeed twenty percent of people identify themselves as chronic procrastinators. For them procrastination is a lifestyle, albeit a maladaptive one. And it cuts across all domains of their life. They don't pay bills on time. They miss opportunities for buying tickets to concerts. They don't cash gift certificates or checks. They file income tax returns late. They leave their Christmas shopping until Christmas eve. They wait till the last moment to turn in their papers.

There is, however, more than one flavor of procrastination. Dr. Ferrari, associate professor of psychology at De Paul University in Chicago, identifies three basic types of procrastinators: arousal types, or thrill-seekers, who wait to the last minute for the euphoric rush; avoiders, who may be avoiding fear of failure or even fear of success, but in either case are very concerned with what others think of them; they would rather have others think they lack effort than ability; and the decisional procrastinators, who cannot make a decision for not making a decision absolves procrastinators of the responsibility for the outcome of events.

All these procrastinators justify their reluctance to prompt actions in various ways. Such as, "I'll feel more like doing this tomorrow." Or "I work best under pressure." Or “ I am more creative when under time pressure”. I asked two of these self proclaimed procrastinators why they did it. One said “ I do some of my best work when I have a deadline. That is when my creative juices flow best”. The other said that he would give me a reply but, uh, later!

In real life, these procrastinators actively look for distractions, particularly ones that don't take a lot of commitment on their part. Checking e-mail is almost perfect for this purpose. So are any kind of hobbies even constant cleaning or indeed gourmet cooking! Anything, it seems, that will allow them to avoid doing the things that they know they need to do.

Unfortunately many a time, procrastinators will deliberately sabotage themselves and put obstacles in their own path. They may even sometimes actually choose paths that hurt their performance. The fact is that procrastination is not really a problem of time management or of planning. Procrastinators are not different in their ability to estimate time, although they are more optimistic than others. "Telling someone who procrastinates to buy a weekly planner is like telling someone with chronic depression to just cheer up," insists Dr. Ferrari.

It is said that procrastinators are made not born. According to one theory, procrastination is learned in the family milieu, but not directly. It is one response to an authoritarian parenting style. Having a harsh, controlling father keeps children from developing the ability to regulate themselves, from internalizing their own intentions and then learning to act on them. It can even be a form of rebellion; one of the few forms available under such circumstances. Contrarily, it can also be a response to an absence of any parental discipline. If no one is imposing deadlines, why bother to do what are clearly less fun things to do. What's more, under these household conditions, procrastinators turn more to friends than to parents for support, and their friends may reinforce procrastination because they tend to be tolerant of their excuses. I have some difficulty with these theories because I have two children one of whom is “gung ho, lets go” type while the other is, lets just say, incredibly relaxed about all deadlines.

Procrastination has always interested philosophers because of its underlying irrationality. They are interested in procrastination because it is a powerful example of what the Greeks called akrasia—doing something against one’s own better judgment. Indeed the essence of procrastination lies in not doing what you think you should be doing but almost anything else. Socrates believed that akrasia was, strictly speaking, impossible, since we could not want what is bad for us; if we act against our own interests, it must be because we don’t know what’s right, that we are ignorant. Another perplexing thing about procrastination is that although it seems to involve avoiding unpleasant tasks, indulging in it generally doesn’t make people happy.

We often procrastinate not by doing fun tasks but by doing jobs whose only allure is that they aren’t what we should be doing. So a fuller explanation of procrastination really needs to take account of our attitudes to the tasks being avoided. Lack of confidence, sometimes alternating with unrealistic dreams of heroic success, often leads to procrastination. Many studies suggest that procrastinators are self-handicappers: rather than risk failure, they prefer to create conditions that make success impossible, a reflex that, of course, creates a vicious cycle.

Viewed this way, procrastination starts to look less like a question of mere ignorance than like a complex mixture of weakness, ambition, and inner conflict. A radical explanation for the gap between what we want to do and what we end up doing is the explanation that the person who makes plans and the person who fails to carry them out are not really the same person! At moments of important decision-making, the mind could be considered as a parliament, a debating chamber where two factions contend, where your short-term interests faction (having fun, putting off work, and so on) is locked in mortal combat with your other faction, which represents your long-term goals. But, if that’s the case, it’s not obvious how you’d ever get anything done: the short-term self, it seems, would always win out. The philosopher Don Ross offers a persuasive solution to the problem. For Ross, the various parts of the self are all present at once, constantly competing and bargaining with one another—one that wants to work, one that wants to watch television, and so on. The key, for Ross, is that although the television-watching self is interested only in watching TV, it’s interested in watching TV not just now but also in the future. This means that it can be bargained with: working now will let you watch more television down the road. Procrastination, in this reading, is the result of a bargaining process gone wrong.

Of course, the easier explanation is that procrastination is really a failure of will and we should seek ways to strengthen the will. This isn’t a completely fruitless task: much recent research suggests that will power is, in some ways, like a muscle and can be made stronger. The same research, though, also suggests that most of us have a limited amount of will power and that it’s easily exhausted. In one famous study, people who had been asked to restrain themselves from readily available temptation—in this case, a pile of chocolate-chip cookies that they weren’t allowed to touch—had a harder time persisting in a difficult task than people who were allowed to eat the cookies.

Since procrastination is driven, in part, by the gap between effort (which is required now) and reward (which you reap only in the future, if ever), narrowing that gap, by whatever means necessary, will clearly help. Since open-ended tasks with distant deadlines are much easier to postpone than focused, short-term projects, dividing projects into smaller, more defined sections helps. Another way of making procrastination less likely is to reduce the amount of choices we have: often when people are afraid of making the wrong choice they end up doing nothing. Procrastination often arises from a sense that there is too much to do, and hence no single aspect of it is worth doing. Underneath this rather antic form of action-as-inaction is the much more unsettling question whether anything is worth doing at all. In that sense, it might be useful to think about two kinds of procrastination: the kind that is genuinely akratic and the kind that’s telling you that what you’re supposed to be doing has, deep down, no real point. The procrastinator’s challenge, and perhaps the philosopher’s, too, is to figure out which is which.

Since procrastination is a learned behavior, can we change it? There are a whole host of books available that claim to remove this blight from your personal life and strengthen your will power. There are a lot of self-help courses you can take. When I urge the procrastinators in my family to enroll, the only reply I get is – later, later.

Old age blues

My wife forwarded this poem to me and it is worth a read. It was apparently found in the effects of a dead patient in Scotland by her nurse.

Crabby Old Woman

What do you see, nurses?
What do you see?
What are you thinking,
When you're looking at me?

A crabby old woman,
Not very wise,
Uncertain of habit,
With faraway eyes.

Who dribbles her food,
And makes no reply,
When you say in a loud voice,
"I do wish you'd try!"

Who seems not to notice,
The things that you do,
And forever is losing,
A stocking or shoe

Who, resisting or not
Lets you do as you will,
With bathing and feeding,
The long day to fill?

Is that what you're thinking?
Is that what you see?
Then open your eyes, nurse,
You're not looking at me.

I'll tell you who I am,
As I sit here so still,
As I do at your bidding,
As I eat at your will.

I'm a small child of ten,
With a father and mother,
Brothers and sisters,
Who love one another.

A young girl of sixteen,
With wings on her feet,
Dreaming that soon now,
A lover she'll meet.

A bride soon at twenty,
My heart gives a leap,
Remembering the vows,
That I promised to keep.

At twenty-five now,
I have young of my own,
Who need me to guide,
And a secure happy home.

A woman of thirty,
My young now grown fast,
Bound to each other,
With ties that should last.

At forty, my young sons,
Have grown and are gone,
But my man's beside me,
To see I don't mourn.

At fifty once more,
Babies play round my knee,
Again we know children,
My loved one and me.

Dark days are upon me,
My husband is dead,
I look at the future,
I shudder with dread.

For my young are all rearing,
Young of their own,
And I think of the years,
And the love that I've known.

I'm now an old woman,
And nature is cruel,
'Tis jest to make old age,
Look like a fool.

The body, it crumbles,
Grace and vigor depart,
There is now a stone,
Where I once had a heart.

But inside this old carcass,
A young girl still dwells,
And now and again,
My battered heart swells.

I remember the joys,
I remember the pain,
And I'm loving and living,
Life over again.

I think of the years,
All too few, gone too fast,
And accept the stark fact,
That nothing can last.

So open your eyes, people,
Open and see,
Not a crabby old woman;
Look closer - see ME!!