Gratitude

This thanksgiving more than ever, my heart is full of gratitude -- to those doctors and nurses, specialists and therapists who during the course of the last two months rescued me from the edge of the precipice. There, but for their devotion and care, I would no longer be here today. So thanks. And, of course, my family and friends who stood beside me through thick and thin- actually mostly thick- praying and lighting the way to my road to recovery. So thanks again.

When in life we are faced with challenges, gratitude opens us to a larger perspective that helps us more effectively address them. When we’re unhappy—depressed, angry, in pain—we contract. The simple practice of gratitude actually begins to relax the mind. Instead of seeing things from only one perspective, we become “open-minded.” The causes of suffering don’t go away, but the context in which they’re happening gets bigger.

“A genuine sense of gratitude has to be rooted in the realization that when I think about all that I am, all that I have and all that I might have achieved, I cannot claim to have done any of this by myself. None of us is really “self-made.” Says EJ Dionne, a Washington Post columnist. “We must all acknowledge the importance of the help, advice, comfort and loyalty that came from others.”

"The one thing all humans have in common is that each of us wants to be happy," says Brother David Steindl-Rast, a monk and interfaith scholar. And happiness, he suggests, is born from gratitude. "Two things have to come together for someone to be grateful: First, we have to experience something we really like, and the second is that it has to be a gift. In other words, it must be a free gift — we haven’t bought it, we haven’t traded it in, we haven’t earned it. It is really a gift to us. When these two things come together — something that we really like is given to us — then spontaneously, in every human being, that joy rises up. It is something that happens once in a while – that gratefulness triggers joy. But we can live in such a way where we are constantly triggering joy. That is, if we realize that every moment is a given moment. Every moment is a gift. ..And with this moment is given to us opportunity. .. And to respond to that opportunity, moment by moment by moment as a free gift, releases that joy that we are really looking forward to as human beings. inspiring lesson in slowing down, looking where you’re going, and above all, being grateful."

But a call to responsibility lies at the heart of gratitude. If faith without works is dead, gratitude without generosity of spirit is empty. By reminding us of how much we owe to others, or to social arrangements, or to fate, or to God, gratitude creates an obligation to repay our debts by repairing injustices and reaching out to those whom luck has failed. Gratitude is a response to acts of love. It demands more of the same — nothing more, nothing less.

For it is said that gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend.

Perhaps Milton said it best: " Gratitude bestows reverence, allowing us to encounter everyday epiphanies, those transcendent moments of awe that change forever how we experience life and the world."

The stupidity of pundits

The last few weeks have been full of the usual inane punditry especially on the cable news. In this case it has focused on obamacare. Having failed in their attempts to first kill it, then defund it and the latest to postphone it by a year,the republican critics have concentrated their ire on the rollout of the program. It seems the webpage design for signing up for insurance was not ready on time and had problems. If any of these pundits had ever worked on a computer they would know that these flubs are commonplace- have they not heard of "beta" programs. Now they have seized on a statement by Obama about people keeping thei insurance rather the new policies which provide greater protection. In all this noise, none of these so called pundits ever inform the public that Obamacare will provide protection to over 30 million people. Not once do they mention the additional protections that are now mandatory.

Of course I have given up watching these clowns realizing that these pundits are merely performers being paid for their faux outrage on screen.-truth and accuracy be damned.

Then there is another set that pronounces the death of the presidency at regular intervals . "Obama has failed and his presidency is dead", they crow' Tom Brokaw in his gravelly voice, pretending a gravity but one devoid of perspective and context regularly prounounces that Obama is a lame duck president with little to show for his tenure' Even Ruth Marcus has joined these band of idiots.  In their latest columns both Dana Milbank and Ruth Marcus are convinced that : "Maybe the president does understand that the game is over." And "Can he recover? I’m sorry to say: I’m not at all confident." Wah-wah, indeed. And all this breast beating because a web page site was not working on the day it was projected! His presidency is unproductive and doomed and he is a lame duck just because the public could not log onto a webpage! Really!

In Washington, Kentucky and Connecticut — the Affordable Care Act, or “Obamacare,” is working. Tens of thousands of  residents have enrolled in affordable health-care coverage. Many of them could not get insurance before the law was enacted. People keep asking why  these states have been successful. Here’s a hint: It’s not about Web sites!

The fact is general disenchantment starts setting in as the poetry of the campaign turns to the prose of governance. Every misstep thereafter is magnified, every error seems to portend the end of the world. In this period, objectivity tends to get lost and people forget all that has been achieved already.

The facts are this president has delivered more sweeping, progressive change in 36 months than the previous two Democratic administrations did in 12 years. "When you look at what will last in history," historian Doris Kearns Goodwin tells Rolling Stone, "Obama has more notches on the presidential belt" than anyone before him.

As president, he has rewritten America's social contract to make health care accessible for all citizens. He has brought 100,000 troops home from war and forged a once-unthinkable consensus around the endgame for the Bush administration's $3 trillion blunder in Iraq and Afghanistan. He has secured sweeping financial reforms that elevate the rights of consumers over Wall Street bankers and give regulators powerful new tools to prevent another collapse. And most important of all, he has achieved all of this while moving boldly to ward off another Great Depression and put the country back on a halting path to recovery.

Along the way, Obama delivered record tax cuts to the middle class and slashed nearly $200 billion in corporate welfare — reinvesting that money to make college more accessible and Medicare more solvent. He single-handedly prevented the collapse of the Big Three automakers — saving more than 1 million jobs — and brought Big Tobacco, at last, under the yoke of federal regulation. Even in the face of congressional intransigence on climate change, he has fought to constrain carbon pollution by executive fiat and to invest $200 billion in clean energy — an initiative bigger than John F. Kennedy's moonshot and one that's on track to double America's capacity to generate renewable energy by the end of Obama's first term.

On the social front, he has improved pay parity for women and hate-crime protections for gays and lesbians. He repealed the policy of "do'nt ask, do'nt tell."He has brought a measure of sanity to the drug war, reducing the sentencing disparity for crack cocaine while granting states wide latitude to experiment with marijuana laws. And he has installed two young, female justices on the Supreme Court, creating what Brinkley calls "an Obama imprint on the court for generations."

The historic progress that Obama has made is especially evident in nine key areas especially if you remember where the U.S was in 2008 before he took over: In 2008, just two years ago, the country faced a fiscal crisis and a second great depression, we were mired in two wars abroad, Dow Jones was touching an all time low of 600 , US was losing 75000 jobs per month,  there were no investments in infrastructure or green technology, the American auto industry faced bankruptcy.And what has Obama managed to do in just five years:

1 | Averting a Depression: his economic team has helped prevent the collapse of the US into the second great depression and the world economy
2 | Sparking Recovery: US economy has shifted from a tailspin to some measure of stabilization and some prospect of job growth and Dow stands at over 15,000
3 | Saving Detroit: GM is now the largest and most profitable car company in the world
4 | Reforming Health Care: Universal health insurance (with promised deficit reduction!) is now law of the land providing coverage to over 20 million of our fellow citizens, covering pre existing conditions, allowing students to stay on their parents plans - a goal sought by Democrats for decades.
5 | Cutting Corporate Welfare
6 | Restoring America's Reputation:Equal pay for women has been passed into law.
7 | Protecting Consumers: The race to the top in education spending has created reform in a large number of states from the bottom up,.The size of Peace Corps has been doubled, Pell grants increased substantially and a major fillip given to Volunteerism. A new Consumer protection agency has been created.
8 | Launching a Clean-Energy MoonShot:Major investments have been made in green technology laying the foundation for the future.A stimulus package has helped undergird infrastructure and will probably do more to advance non-carbon energy than anything that might have emerged from Copenhagen.
9. In foreign affairs, he has quietly managed to disarm Syria of its chemical weapons- Assad has been forced to acknowledge the possession of chemical weapons and to their destruction under UN auspices, and started a dialogue with Iran, after 39 years, for nuclear disarmament. Given the hysteria of these so called pundits along with the hawkish politicians, this is no mean achievement.

These are the facts the bloviating pundits conveniently ignore.

So now I treat them as I would when I go to the circus-just one more clown taking his turn in the spotlight for his daily bread.

I would advise you to do the same.

Home at last

Chinese have a saying " May you live in interesting times". Well, the last six weeks have certainly been a fascinating period in my life. Not one I would like to repeat but interesting nevertheless less. And as usually it happens it started with as a small thing. In my case it was  a tiny blister on my foot. Since I was a diabetic I had been warned to pay special attention to any such outgrowths.

After some initial hesitation, I made a beeline for my doctor. He took one look at the offending foot, and urged me to leave for the hospital forthwith. So there I was in my hospital bed listening to various specialists pronouncing on my fate and prognosing a bleak future indeed unless I took a dialysis regime to clear my body of the accumulating toxins. Thus followed a hospital stay, then a rehab nursing center and finally permission to return home under a strictly supervised regime.

Here is a brief diary of he next few days..?

It had been seven years since I underwent quadruple bypass surgery at the best heart center in the US. Unfortunately that experience had left me with an ejection fraction of 15% barely adequate to pump the heart. During the past few years, three doctors had managed to skillfully redesign my life to a relative health. But now I was back again having fallen off the strict regime which had upset the chemical balance of my body.

One of the prime culprits was a new drug called Lyrica. Now I love my doctor-he is kind, considerate and so far his judgments (I have had him now for 25 years) and advice have been sound. But once in a while his judgment slips. Unfortunately it happened last week...He had prescribed Lyrica, a brand new drug, a month ago to alleviate my PHN pain a result of a bout of shingles the previous year. But he had not taken into account it's possible side effects!

Apparently Lyrica had built up in my body raising both the creatinine and bun levels ( both measure the functioning of the body’s kidney functions) beyond the danger levels. Alarmed at the new levels he now recommended a right heart  catherization and an iv drip. Except that I had become so weak as a result of Lyrica thatI felt that the procedure may be a real danger to my life. So I refused the procedure then, only to reap the fruits of my delaying and leading to the emergency trip to the hospital! 

 I entered the hospital and soon enough found myself engulfed with various experts. During my first seven days scores of specialists visited my bedside but three standout, because each of them predicted my demise with different degrees of subtlety. One prognosed that the only solution to my condition was a heart transplant. But a few years earlier, John Hopkins, after a detailed assesment had declined to place me on the list because of old age of 70. Another suggested an LVD but in the present condition it was not possible. A third assesed that dialysis was only a temporary fix --in short, I should get my affairs in order ( and this in presence of my daughter who was understandably distraught). Another suggested I focus on Gita . In short all of them saw but a limited lifespan left for me. Fortunately my old cardiologist was there to provide a common sense path forward. And that led to the dialysis in the hope that it would rid the body of the toxins that had built up.

You need dialysis when you develop end stage kidney failure --usually by the time you lose about 85 to 90 percent of your kidney function. When your kidneys fail, dialysis keeps your body in balance by: removing waste, salt and extra water to prevent them from building up in the body, keeping a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate, and helping to control blood pressure.

Chronic kidney disease and GFR - glomerular filtration rate is the best test to measure your level of kidney function and determine your stage of kidney disease. Your doctor can calculate it from the results of your blood creatinine test, your age, body size and gender. The earlier kidney disease is detected, the better the chance of slowing or stopping its progression. One in 10 American adults, more than 20 million, have some level of CKD.

Actually some kinds of acute kidney failure do get better after treatment. In some cases of acute kidney failure, dialysis may only be needed for a short time until the kidneys recover. Dialysis can be done in a hospital, in a dialysis unit that is not part of a hospital, o r even at home.

The dialysis machine is really a very simple machine which takes blood through one tube and returns it to your body through another. The machine itself does all the work of cleaning the blood and removing the toxins from the body. So you go in twice or thrice a week, are tied to one of these machines ,and after three hours you emerge with considerably cleaner blood. The hardest part is lying on a bed for three hours!

Heartened by the progress I moved to a rehab nursing home
for the early days of my dialysis. There were a number of patients at the center being rehabilitated for a number of ailments from Alzeimer to kidney failure. There was a CEO painfully learning to recognize what day of the week it was, a high school teacher determined to walk again, a grandmother surrounded constantly by her children and grandchildren, a lonely old man who cried at night. Yes, it was a varied mix of humanity. And those looking after them were a varied lot indeed. While management was mostly white, specialists were mostly Indian, daytime nurses were the local black, but night time nurses were tall strapping women from Africa- Somalia, Nigeria, Eritrea.

There was physical therapy, occupational therapy and varies other regimes to get you back on your feet. I learnt a lot from this regime; from how to walk, first with a wheelchair, then a a walker and finally on my own, how to urinate lying down, getting up from comfortable sofas, and sleeping on beds surrounded by bars, being woken by a floating cast of nurses at all times of night and day and constant pricking by needles drawing blood. Oh, those needles!

After ten days I was ready to go home!

During my stay both at the hospital and the nursing home, I was greatly heartened by the calls from family and friends enquiring about my state of health. I has often written about how it was difficult to console friends in times of tragedy, but now I had a new perspective with my views being leavened with having been on the receiving end too.
 So what can I tell you about how to console friends in their times of travail.

So what words of wisdom can I now pass on to you when you venture to console your friends in their times of trouble?

The first, do call or write. The very fact that you took the trouble to do it is heartwarming to the patient that he is in your minds and prayers are very reassuring.

When you write recall incidents in the past of happier times together and urge them to get well soon for happier times to come

It is true that when you call, emotions often take over despite your best efforts. But you need to control the urge to commiserate or cry. Rather focus on the serious cheerful. For example once a friend called and said " I want you to get well soon so that I can fight with you about Obama and the state of the country" or another "Keep it up Anil! It's always great to be alive, (and to have you with us) no matter how difficult it is to stay involved!!" "All I can say I am so happy to see this to know you are on your way to getting back to your old life! Hope you will be out of hospital/re-hab real soon now. Lots of love and good wishes from all of us,"

All these messages and calls are a reminder that you are still loved and missed and that you have a life, a trifle altered, still awaiting you ahead.

Remember your words will provide "Comfort on difficult days, smiles when sadness intrudes, rainbows to follow the clouds, laughter to kiss your lips, sunsets to warm your heart, hugs when spirits sag, beauty for your eyes to see, friendships to brighten your being, faith so that you can believe, confidence for when you doubt, courage to know yourself, patience to accept the truth,  and Love to complete your life"

And finally , if you can, simply sit by their side - quietly , gently- simply sit. No words are necessary; your very presence says it all. That will be the most soul satisfying moments of them all.

Back at the nursing home, a month has passed. And boy, what a month it had been! From a near unanimous prognosis of a few days left on the death bed to walking home after thirty days of pain! The very thought of going back to some semblance of my former life cheered me immensely.

And it had all started with a swelling of my feet-an indicator of edema increase. Mine had, it seems, gone beyond limits. So I was rushed to the hospital and then followed some of the most painful days of my life. But now I was going home and that was all that mattered...

But in a sense you cannot really go home- the world has changed, your environment is no longer the same, and the people you knew before you went away too have pursued their own lives. And don't forget you have changed too- after all the turmoil has to have left a mark on you too.

The key to a successful return is to recognize these changes and to learn to adjust to  them. For example, in my case, one of the hardest tasks was wearing shoes and getting into the car. Others included walking everywhere but with a walker, ensuring that all the medicines were at hand, and that oxygen boost was available, reorganizing the house with a special bed, shower chair, and bedside toilet, and getting a wheelchair for those long journeys to cinemas and restaurants ( one can dream cant one?). Nothing was a great hardship but only if one planned and organized for it. Life could be managed, I found,if one put ones mind to it.them. I certainly found that in my case. I found myself speaking much less and thinking and reflecting more,  appreciating the little kindnesses and courtesies. Gradually I found curiosity about my surroundings slowly reemerging and writing, albeit slowly, became once again a joy.

Yes it seemed I had almost touched the pearly gates but had been to my great surprise denied admission at least at this time....so now it was upto me to make the best of the extension of life granted me.

What had I learnt from this journey...

Doctors don't know everything --As Jerome Groopman wrote on average, a physician will interrupt a patient describing her symptoms within eighteen seconds. In that short time, many doctors decide on the likely diagnosis and best treatment. Often, decisions made this way are correct, but at crucial moments they can also be wrong  with catastrophic consequences.

Nurses are grossly under appreciated. “Constant attention by a good nurse may be just as important as a major operation by a surgeon. “ ~Dag Hammarskjold . Nurses dispense comfort, compassion, and caring without even a prescription.

Your family is everything. During the entire period my family stood like a rock beside me-my daughter took leave to spend nights massaging my back, my son flew back from Vietnam to reinforce her ministrations and my wife was an ever present presence in the room. Without them it is unlikely that I would be writing this blog!

I learnt patience and becoming careful in my words, even a trifle timid. I learnt the joy of watching the daily sunrise, hearing the conversations of those around me, and watching my grandson dance!

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Wait, wait , What's your hurry!

"Procrastination is the thief of time" said the bard, and urged all to abjure it. But that is harder to do than it looks..

"Avoid procrastination" is slogan so elegant in its simplicity. But the thing that neither the dictionary nor fake procrastinators understand is that for a real procrastinator, procrastination isn't optional—it's something they don't know how to not do.

To understand why procrastinators procrastinate so much, let's start by understanding a procrastinator's brain.

It seems the Rational Decision-Maker in the procrastinator's brain is coexisting with a pet—the Instant Gratification Monkey.This would be fine—cute, even—if the Rational Decision-Maker knew the first thing about how to own a monkey. But unfortunately, it wasn't a part of his training and he's left completely helpless as the monkey makes it impossible for him to do his job.

The fact is, the Instant Gratification Monkey is the last creature who should be in charge of decisions—he thinks only about the present, ignoring lessons from the past and disregarding the future altogether, and he concerns himself entirely with maximizing the ease and pleasure of the current moment. He doesn't understand the Rational Decision-Maker any better than the Rational Decision-Maker understands him—why would we continue doing this jog, he thinks, when we could stop, which would feel better. Why would we practice that instrument when it's not fun? Why would we ever use a computer for work when the internet is sitting right there waiting to be played with? He thinks humans are insane.

In the monkey world, he's got it all figured out—if you eat when you're hungry, sleep when you're tired, and don't do anything difficult, you're a pretty successful monkey. The problem for the procrastinator is that he happens to live in the human world, making the Instant Gratification Monkey a highly unqualified navigator. Meanwhile, the Rational Decision-Maker, who was trained to make rational decisions, not to deal with competition over the controls, doesn't know how to put up an effective fight—he just feels worse and worse about himself the more he fails and the more the suffering procrastinator whose head he's in berates him.

It's a mess. And with the monkey in charge, the procrastinator finds himself spending a lot of time in a place called the Dark Playground.

The Dark Playground is a place every procrastinator knows well. It's a place where leisure activities happen at times when leisure activities are not supposed to be happening. The fun you have in the Dark Playground isn't actually fun because it's completely unearned and the air is filled with guilt, anxiety, self-hatred, and dread. Sometimes the Rational Decision-Maker puts his foot down and refuses to let you even have unfun leisure time, and since the Instant Gratification Monkey sure as hell isn't gonna let you work, you find yourself in a bizarre purgatory of weird activities where everyone losess. And the poor Rational Decision-Maker just mopes, trying to figure out how he let the human he's supposed to be in charge of end up here again. Given this predicament, how does the procrastinator ever manage to accomplish anything?

As it turns out, there's one thing that scares the shit out of the Instant Gratification Monkey: The Panic Monster is dormant most of the time, but he suddenly wakes up when a deadline gets too close or when there's danger of public embarrassment, a career disaster, or some other scary consequence.
The Instant Gratification Monkey, normally unshakable, is terrified of the Panic Monster. How else could you explain the same person who can't write a paper's introductory sentence over a two-week span suddenly having the ability to stay up all night, fighting exhaustion, and write eight pages? Why else would an extraordinarily lazy person begin a rigorous workout routine other than a Panic Monster freakout about becoming less attractive? And these are the lucky procrastinators—there are some who don't even respond to the Panic Monster, and in the most desperate moments they end up running up the tree with the monkey, entering a state of self-annihilating shutdown.

Of course, this is no way to live. Even for the procrastinator who does manage to eventually get things done and remain a competent member of society, something has to change. Here are the main reasons why:

1) It's unpleasant. Far too much of the procrastinator's precious time is spent toiling in the Dark Playground, time that could have been spent enjoying satisfying, well-earned leisure if things had been done on a more logical schedule. And panic isn't fun for anyone.

2) The procrastinator ultimately sells himself short. He ends up underachieving and fails to reach his potential, which eats away at the him over time and fills him with regret and self-loathing.

3) The Have-To-Dos may happen, but not the Want-To-Dos. Even if the procrastinator is in the type of career where the Panic Monster is regularly present and he's able to be fulfilled at work, the other things in life that are important to him—getting in shape, cooking elaborate meals, learning to play the guitar, writing a book, reading, or even making a bold career switch—never happen because the Panic Monster doesn't usually get involved with those things. Undertakings like those expand our experiences, make our lives richer, and bring us a lot of happiness

So what should we do? Ah! There's the rub! For nobody has figured out the path to break the cycle of procrastination!.