Back Next Home The inoculated
system
Mr. Godwin Simon sat waiting his turn at Professor Mechanic’s liver clinic with a worried expression displayed on his LCD screen. His blood tests suggested that his system was infected with a bad virus that was possibly fast damaging valuable files on his hard disc. One of his friends had recommended Professor Mechanic’s liver clinic and he was quite hopeful and yet couldn’t stop worrying. Also he was feeling a peculiar heaviness in his lower limbs especially since last night after his wife noticed they were swollen. That was definite sign of a promising future system trouble, the very thought of which made him even more depressed. This was on top of the fact that his business hadn’t been doing well lately. The sweet shop he ran was affiliated to a popular brand, “Slurp”, with a chain of monoclonal outlets around the countryside. Recently the company had suddenly decided to close down countrywide (although his particular shop was selling well). There was some story about the son in law taking over after the owner father in law’s death and selling his company off for a better business nearer to his own heart. Godwin had no immediate options but sell sweets from local small time sweet manufacturers in the country. His customers who relished the “Slurp” brand didn’t take kindly to the fact that Godwin was still using the name “Slurp” in the neon sign outside his shop (originally provided by the company who didn’t bother to reclaim it) while selling unbranded non media hyped local goods (which Godwin personally felt weren’t less tasty). Godwin was angry at “Slurp” for having ditched him and other “Slurp” outlet owners who were making reasonable money to feed their families, angry at globalization for having given birth to “Slurp” in his small town business that was otherwise getting along fine without it before it came along with promises of slurp-more (slurp-plus) money. His anger was soon quelled by fear, the fear of not finding another suitable ‘slurp’ or ‘burp’, the fear of resulting penury, eviction of his bright child from the local good school due to non-payment of fees, having to resort to selling his wife’s jewelry and now this virus. He felt his system crashing along with his whole world coming to a hanged standstill. Professor mechanic informed him that the virus had already made sufficient forays into most areas inside his liver, systematically destroying each and every hepatocyte file. His leg swelling was due to an excess fluid in between the cells in his leg. The interstitial ocean showed up as edema due to an excess fluid of three liters inside his Earth. There was excess fluid also inside his belly, in the peritoneal bag covering his intestines along with other organs like the liver inside his abdomen. This flood of fluid explained professor Mechanic, resulted mainly from a fibrosed liver with blocked inlet pipes because of repeated inflammation and healing around its microscopic hepatocytes all stimulated by an idiotic hitchhiking virus. Hep-B, the professor called it (a bit rather too affectionately thought Godwin). It also struck him odd that Professor Mechanic should say that the virus wasn’t responsible in itself for the destruction of his hepatocytes. It was his own system’s immune cells that were responsible for all the carnage as they went on a trigger-happy shooting spree burning off all the hepatocytes in their attempts to target Hep-B.
The Letter from a
virus 1
June found Mr. Godwin very polite and co-operative soon after his admission to the ward, inspite of the fact that he was obviously depressed. On doing a physical examination she found his limbs swollen along with the fluid in his belly. This was removed by her senior for testing to confirm that the fluid was all due to an increased pressure in his liver. That night Mr. Godwin couldn’t sleep well. He woke up next morning to find June at her bedside. He was feeling groggy and she seemed to be asking him to keep his hands extended from his wrists for some time. He wondered why one would want him to do that. Nothing seemed to be making much sense any more since he had been admitted to the hospital. Last night he had received this letter from the virus that was supposed to be habiting his system, which from the virus’s microcosmic perspective seemed a huge universe of its own.3
Dear Godwin, I am a Hep-B virus amongst the now countless many inside your system
liver. It is a desperate attempt to reach out and communicate a tale of our
life long struggle in a community hated and hunted from its very inception. The
present state of affairs is such that we
are nearing a perishable climax but more importantly, we
seem to be dragging down your system the body of Earth as well. We were originally a tribe
of fishermen living off the ocean, in the west coast of a huge
landmass of Hepatocytes. Our earliest settlers had arrived on its shores long
back and a strange tale of their appearance has passed down verbally over
generations. They claim to have frequented a similar planet, with oceans,
islands, palm beaches and plenty of fun and frolic. Once, on a yachting trip, his majesty, the HBV virion
along with HBeAg and HbsAg, two of our ancestors (at
that time probably in their teens) rode the waves a trifle bit longer than usual
until the main land mass of Hepatocytes grew smaller and smaller, at a
distance. There was a dark orange hue to the sky as the sun left an uneasy
calm. It all began at that moment when both of them prepared to tackle a rather
gigantic wave approaching and lifting them up. It became larger and larger,
assuming proportions of a gigantic mountain. Preparing to meet death, they suddenly found a huge steel tunnel
piercing the sky and descending on to the ocean. They watched open mouthed as
the gigantic tube sucked all the water along with them into its claustrophobic
insides. It was, as if they were swept into another dimension and some of us
wondered if it was a near death
experience. After, a time, there was another gush of water from
the other end of the tunnel, probably water being emptied somewhere, thought HBsAg as he hung on to the sides of the tunnel with all his
might. Before, long their tunnel pierced again into another good old
three-dimensional earth and as soon as it touched the ocean, our boys started
swimming for dear life. This time there was no suction vortex and they managed
to swim over to a similar landmass of
Hepatocytes. It was a complete virgin land in those days. None
of the gory sky scrappers you see in the present concrete jungle. There were
lush green fields bordering on dense forests, a hut or two, a fire to keep you
warm for the night and that was all the smoke it produced. Not like the smokes
of presently upcoming power plants. 67 Letter from a virus 2 Our ancestors
arrived like Great place!
Thought the king and settled down, had children, another life, and another
kingdom. Now we Hep -B viruses don't enter into sexual relations that easily
but prefer to replicate our own DNA, so the king sat to meditate. His
deficiencies and gaps were filled and he became a covalently closed circular DNA (or you could
say he was totally covered up in a termite mound). The CCC-DNA was extruded out
of one of the windows and then the mound broke into three pieces of slithering
snakes, ready for transcription.
It proceeded with the synthesis of a minus strand followed by a plus strand and
finally we had baby HBVs. The first
threat of an external aggressor appeared around this period. It wasn't anything
to do with the natives within the nucleus who were pretty docile and never
troubled us. It was the ocean predators. They were
probably the other inhabitants of this vast body of earth in areas, which still
remain unexplored. They started off by attacking our children. Dear little baby
peptides dressed in colorful epitopes loved playing
in the beach. We never thought they would draw the attention of those detestable classes of MHCs.
They would play with our children and hold them up in the air from time to
time. Little did we know that this would be a signal for their CD-8 (seedy-ate) ally that is until
the first bombardment. The hepatocyte shores went up in flames. Fire spread rapidly,
lighting up the usually dark jungle silhouettes. Across another corner, in a
dim glow, one could barely discern other dark shapes getting down from odd
looking boats, starting to drill the earth with perforin
drillers and pouring poison into those drilled perforin channels . The ravages
we have survived along with our coveted land are a tale often repeated. I
guess, every society has its persecutors, bombardments and yet life begins
anew. Many of our brothers devised increasingly cunning ways of eluding our
seedy attackers. It’s been a topic of research among you humans (some of us
refer to you as Demons/Gods). Mechanisms of persistence of Hep-B viruses in chronic
carriers, is a hot issue, the complete unraveling of which might push the
final nail into our coffins. However, before that I seriously believe and wish
to convey that your body of earth itself is in jeopardy. Letter from a virus 3
Mechanisms Of
Hbv Persistence
Some of our HBV brethren left the hepatocyte
shores and swam with the strong oceanic currents to seek refuge in other
greener pastures...kidneys, brain, testes, pancreas and the like. The seedy
cells couldn't pursue them all the way to these places apparently dissuaded by micro-vascular anatomic barriers,
which surprisingly are lacking in the Hepatic sinusoids. Other than this, some
of us tried to fox the MHCs by mutating the epitopes in our babies to evade recognition by seedy eyes.
Then there were some peculiar natural factors, which came to our rescue as
well. The MHCs we learnt were essentially polymorphic
and all MHCs were not equally bad and some of them
just played with our kids. The MHC II came perched on macrophages and these
giant whales required a daily rubbing
of Vitamin D oil on their surface, to actually stay active. Recently some
of your people discovered a mutation (T to C at 352 position)
in the Vitamin D receptor gene that might lead to inadequate activation of these
killer whales. These whales also love to eat with a particular sauce (mannose binding lectin)
and again this was successfully adulterated. Another ploy that we had to devise
was born out of sheer desperation in our continued struggle against the seedy cells.
One night, hordes of our guerilla forces attacked a fleet of passing PBMCs (peripheral blood mononuclear cells),
climbed onto their ships and took over after a bloody battle. Their wireless
system with which they used to summon more and more seedy cells were
effectively silenced. Letter from a virus 4
Carcinogenesis
Other avenues
of survival opened up in our very homes inside the hepatocytes.
The local people we noticed were surprisingly immune to seedy attackers. They
had disagreeable features but in the interest of survival we started marrying
into their communities (effectively, integrating
with our host genomes). We married and multiplied into a modern
cosmopolitan society. Gradually, we lost our food gathering nomadic existence and
settled into concrete stable dwellings with equally fine-processed food to
satisfy us. Multi-storied buildings started adorning our skylines. Gone were the palm trees, green fields were encroached by collagenous cement that hardened with each passing day. You
could almost hear the muffled cries of earth as it stifled over this new
overpowering burden. Since the
early part of this century ...we had continued to rebuild and regenerate after
each and every seedy attack. However regeneration and degeneration can leave
ugly scars. Presently we have had the unfolding of another interesting
scenario. The seedy missiles having been silenced, what we have now is simply
growth and more and more growth. Some of us
have begun to see through all this growth and realize our days as well as that
of the earth are numbered. It's only a matter of months now. That is, if we
can't devise new ingenious methods to escape our present predicament. Life is
generally defined by some universal traits, which we suspect might be present
even in you humans. It might be present even in the myriad subatomic particles
that make up our relatively puny bodies. 70 Letter from a virus 5 The earth
which we live in seems similar to your earth and we are accumulating enough
evidence (partly through internet) that it’s inside you humans where we might
be residing (like your concept of a living earth). Therefore, this uncontrolled
growth of our civilization might be the death of your body and therefore this
desperate communication (By the way, is the growth of your society too
progressing exponentially - really, this concept of parallel universes is
fascinating). Life grows as
an expression of its universal traits, chief among which is a perennial
dissatisfaction with the present and an insatiable urge to change, replicate
and evolve. Look at our evolved bodies, added up from myriads of subatomic
particles and look at your body (our earth) even more highly evolved and yet
yearning for more. More love, more growth, more reproduction both in thought
and form ... yet survival is the name of the game and we have evolved over the
years, just to survive. I am confident some of us will manage it even in the
wake of this global cancer. As night
falls, a few dark silhouettes among us have been noticed to wade out with their
rubber dinghies into the deeper waters of a darker ocean, hoping against
hope.... someday ... another tunnel, another universe, fresh green rice fields
bordering dense forests. Clouds you'll notice, too exhibit living characteristics
of a non-linear replication, summation and accumulation, which from time to
time, bursts into a downpour, catching you unawares in the rain. We wanted to live like a cloud but ended blowing up
in smoke. Yours truly, Hep-B alpha Godwin had suffered a blood vomit that very night of his first day of admission and in the morning he was found by June to be a bit drowsy. He was in a confused state and June found his hands flapping when he tried to obey her request for keeping his hands extended. An ultrasound examination that very evening he got admitted had shown a tumor in his liver. Mr. Godwin died the following day, mercifully saved June thought from all the treatment that would have followed if he had survived. Godwin’s elder brother had come to take his corpse and on his request she removed some of the fluid from his lifeless belly as that definitely made it lighter and easier for them to carry. Hunger for food and
air
June now in her 7th semester is
posted in the tuberculosis ward of her hospital right in the heart of the city
of She continued her patient interviews and was taken up by another lady who appeared pale and yet cheerful as June approached her. She had been diagnosed with tuberculosis long back 10 years ago she said when she was just 25, that was a few months after her marriage and her husband had left her in the village to come to this city in search of a job and never returned since. She had lived off her parents and brother for a while but had to leave them too eventually, as they couldn’t bear the cost of her treatment. She took up the job of a sweeper in the local health center in the next village. She learnt quite a few medical things there as the doctors and paramedics in the center would use her as an all purpose help and village patients soon became used to her sweeping the floor of the clinic and at times dropping the broom for the hypodermic syringe that she would stick into their posteriors with equal élan. On doing a physical June discovered she had an increased breathing rate more than normal and there was a peculiar caving in of her right side of upper chest. The sounds too of her breathing that she heard in that area of her chest were definitely not normal. They were more of hollow, tubular rather than the normal soft rustling. Even tapping on that area with her fingers produced a dull sound rather than a resonant note. She could also see that the big air pipe into her lungs and her palpable heartbeat had shifted to the same side as the caved in area of her chest. She asked the other lady doctor in the room about what morphologic diagnosis that would suggest and she said, “Looks like a right upper lobe of lung collapse possibly due to fibrosis as a result of her old tuberculosis.” As June got ready to leave, the patient suddenly asked her if she could request the hospital authorities to ask the kitchen help to give her a little more rice in her lunch as she felt so very hungry even after finishing off whatever they provide. Looking at the surprised expression on June’s face the lady doctor laughed and said, “These poor patients never get enough to eat. The food they give them is horrible and yet they hunger for more. Actually the government has sanctioned enough money for good and adequate food for them at each meal but half of it unfortunately makes its way into the neighboring restaurants sold off by the hospital kitchen staff who have a shady liaison with them. This is our country, as physicians we can only practice and make money but we can’t have our own sincere research. We leave the research to the West, as we don’t have enough to eat. Fly off to US if you get the chance.” Airways opening
into system-rivers
Professor Mechanic resumed, “Approaching patients with disease in the lung and the bags covering it can be tricky as well as easy at times. The lungs can collapse like punctured balloons either due to an obstruction in its air pipes, the air in it getting absorbed by its rivers or they could cave in due to fibrosis that follows any inflammation. The balloon like air spaces inside the lungs can be filled with pus due to infection or they may develop tumors. I shall take you to the Lung wards where we can meet an assembly line of systems with afflicted lungs in all its variety. You see this 35-year-old lady she has a caved in right upper chest with a dull note on finger tapping and a breathing sound that is hollow tubular…Collapsed right upper lobe due to old tubercular fibrosis. This 25-year-old girl with wheezy sounds from her chest and breathing difficulty has a spasm in her airways because of an inflammation there again stimulated by her system immune cells responding to foreign particles. This 50-year-old smoker has just the opposite of what you saw in the 35-year-old lady. He has a bulge in his right upper chest instead of a caving in but then the dull note on finger tapping and the hollow tubular sound are also there. This patient has a tumor within (what we call a morphologic diagnosis of right upper-lobe lung mass). Post modern post bed-side
student conversation
Tap-tap the back of this patient on his right, a golden backed woodpecker hammering on an old oak tree…Sounds normal eh! Tap-tap the front of his chest…um…sounds dull on the right upper part, the distant thud of a woodcutter at work, deep inside a dense forest. Now place your stethoscope on its back, the gentle rustle of a summer breeze traveling through pine forests bordering on moonlit sands. A normal vesicular breath sound right! Now listen to the dull area you just tap-tapped. Uh! Oh! A bunch of jungle babblers engaged in furious conversation. What does it look like? Um…fine discontinuous high-pitched crackling sounds. More like firewood sputtering eh! Possibilities are, right upper lobe fibrosis due to old tuberculosis or right upper lobe collapse due to an endo-bronchial growth with post obstructive pneumonia. Wait a minute! What’s that growling sound? Aw! Gwan…I remember the fright you gave me in Ranthambore! It turned out to be only just an insect and not a tiger after all. I am sure…I’ll be…there’s definitely something in there…deep down…maybe. Oh well, we do know that lesions deeper than 5 cm within the lung may not be audible. Could it be a solitary pulmonary nodule? Never heard of it producing such a sound, a solitary hermit perhaps deep inside a forest, engaged in conversation with a tiger. Moving muscles and stories June was
waiting in the hospital corridor for her case to be allotted when she suddenly
noticed an interesting machine walking in a peculiar manner with his limbs
snipping the air between his thighs like a pair of delicate scissors. He didn't
seem to be in much of an agony but did have difficulty in dragging his stiff
limbs. June knew this had to be an electrical problem and eagerly followed him
to his bed. "Machine
movement, began Prof Mechanic, is primarily due to muscle cells attached like
flexible bands over the rigid skeletal rods termed system bones and with each
and every electrical stimuli there is a contraction of all these muscle cells
that make the flexible bands contract producing a torque to the skeletal rods,
resulting in movement. Movement could be impaired due to either the muscles
drying up on their own fashionably termed myopathy or
due to improper electrical firing into the muscles. If the current flows
through them too much it causes the muscles to go awry resulting in stiffness
of the limbs. This too much of erratic current could be due to a loss of
inhibitory signals from the ICs in the spinal generators because of damage to
their wires (fashionably termed the upper motor neuron, which indicates their
source and distribution). The wires of the upper motor neuron start from cells
in the cerebral cortices, which most machines carry in a skull casing that also
houses its own LCD display at the front, termed face, replete with more muscles
and finer circuits for facial expression. The same wires travel through an internal
capsular area and the brain stem inside the skull, in pyramidal bundles and
finally reach a station labeled "Anterior horn" where the upper motor
neuron train stops. Another bunch of neuron wires called the 'lower motor '
take off from there and reach all the muscles in the human machine. As current
increases in upper motor wire damage it leads to a chaotic state of increased
muscle contractility making them spastic.
Lower motor wire damage has the opposite effect and makes them flaccid
and limp. The machine is hardly able to move a muscle at all. A galvanometer
testing the muscles would register no current. With time the muscles atrophy
and the limb is just a rod." Possibilities Jumping and
quivering June
followed the young man to his bed with her galvanometer which was this plastic
thing resembling a hammer. He was a bright boy preparing for his pre-meds and
had topped his class in his village schools up in the mountains of Garhwal. His muscles
didn't look wasted at all. His muscle power wasn't that bad either, in fact it
nearly equaled June's own as she asked him to flex his elbows but then on
striking his muscle tendons in his upper and lower limbs June found them
jumping and quivering. It was evident that the current flowing through them was
quite strong but obviously misdirected due to malfunctioning ICs in his spinal
generators. Somewhere in the thick bunch of wires especially as they ran in the
area of his spinal cord at the back of his neck (termed the 4th cervical
segment) was the lesion (the morphologic diagnosis). What was it that was
disrupting the ICs there? Was it a tumor? (Unlikely, the machine had almost
grown up with the malfunction). Was it the skeletal vertebral casing
compressing the ICs causing cord dysfunction that was something treatable?
Again looking at his back June couldn't find anything wrong with his vertebral
column. Was it some blood pipe to the spinal circuit that had got blocked,
drying up the ICs? Was it an inflammatory demyelination,
a condition where the ICs lose their myelin sheaths (they help the current
flow, jumping saltatorily over their nodes of Ranvier)? Unlikely again because both would have had an
acute onset and the latter would have shown signs of recovery as soon as a new
sheath replaced the old one in the ICs of the cord. It looked
more like as if the cells forming the ICs in the spinal cord had died on their
own, a process termed apoptosis, which might have been triggered off by an
external event, the entry of an email virus or may have been a consequence of a
genetic software program inbuilt into his operating system. Seems as if it was
just the other day Kris
noticed June for the first time in Samsara's akhara during the winter festival
in Bolpur, a place enriched by the past of Kris
spotted June with her father singing the Baul
songs he loved. She had a strong voice that seemed to have been well honed in
Indian classical. They were flanked by Samsara's students who were also eyeing
June. Kris didn't know how to approach her. She had this long hair in plaited
braids and a smile that melted Kris. He wanted badly to know more about her,
talk to her and then suddenly it all just happened. Samsara had begun singing
and as the audience reshuffled he found June squeezing in beside her both of
them sitting crosslegged on the floor with one of
June's knees snugly nested against Kris's thigh, both hidden behind a thick
layer of Sari and trousers. It was June
who spoke first. "Are you an Engineering student?" Kris gulped (only
momentarily), "Well no. I am As June and
Chris walked into the moonlit night they crossed the Saal
Bithi ,
a small 76 Like a whiff of rain swept Earth After the secondary school leaving certificate, which June topped there was this higher secondary school leaving certificate that needed to be topped and Kris was healthy competition. Both would meet more often exchanging notes, differential calculi and physiology of the cockroach amidst a few unconventional write ups that June would pen down from time to time in her diary, again a legacy inherited from her illustrious father. June’s diary Dear Kris, Sometimes, it seems as if it was just the
other day you turned up suddenly out of the blue, gave us a pleasant surprise. Remember…the roller
coaster ride on top of a rainbow, stopping to chat with a flock of geese
returning, sleeping awhile on soft cumulus clouds. You’ve been away for long yet, now that its time for sunset, the stars seem to lie in wait for someone, before they start peering out, in countless dazzling millions. If you could manage some time do visit us soon. Long since we bathed together in the darkness and quenched our thirst on the other side of the moon. Kris’s note: Dear June, You stepped into my dream, like a whiff of rain swept Earth. A cool breeze blew through the windows while the rain…created music outside. The room bore your silent eyes and me lying on the mat. From an unearthly distance you bent down and breathed softly into me, while I …kept on struggling to reach you, through dense jungles, steep slopes, gradually you receded into that never ending corridor. The results were out and June had topped
again this time securing admissions into most of the prestigious Medical and
Engineering colleges in Eeeeek,
or should it be mmmmmmmmmmf...I sniff some pain, a
deep breath or two. June and Kris
pass their medicine finals and June is expectedly at the top of the list. Both
start their internship enthusiastically. However, June notices Kris gradually
starting to ignore her. One day Kris discloses his plans to go to US for which
he's being financed by a mysterious uncle. June can't afford it herself.
Samsara with his meager professor's salary can hardly cater to all the demands
of Maya and Dupki, her younger brother. Also money
would be needed for her brother's engineering school and Samsara's Baulish
antics were far from paying. June would have just loved to go to US. If only
Kris would have offered to look after her there, but no he was being very
secretive about his uncle in US who wanted to see him there alone. Most of
June's class acknowledged that even if one single person was to score the
highest in the The Indian
Institute of Trouble-shooting-humans(IIT), post graduate entrance exams were
the toughest in the country not only because it was an institute of national
importance with all Governmental grants directed towards it, that made it
highly covetable but also because of a system of in house reservation for
students who had already graduated from that institute. Off course they had
only been able to do their graduation from there because they had cleared
another tough entrance exam at the pre med school level, the one that June too
had cleared but had forfeited in preference to studying at medical college,
Kolkata, just to be with Chris. Now that Chris was out of her life, June was
free to try out her luck again this time at the IIT for gaining entry at a post
graduate level. June never needed much luck. Or is it that she was lucky to
have got such marvelous brains. A photographic memory allowed her effortless
data storage in her hard-disc with an infinite capacity. In addition a super
fast clock speed with a very high random access memory allowed her effortless
data retrieval. If life had been hard to June in matters of heart it was extra
kind to her brain. She was relieved to see her name in the merit list right at
number one. Relieved not only because she had something good to fall back on
(if not US) but she was also going to get a good stipend as a post graduate
resident. This would also allow her to sponsor her brother's undergraduate
engineering school. House plants cruising through
summers bliss June
decided it was time for her to chill out and relax on the system trouble-shooting
after all, things were not that dim for the future. She had a secure job as an
MD resident and there was a saying about the institute that if one just managed
to keep one's eyes and ears open while working in the hardware lab located in
the wards of this teaching hospital, knowledge would seep in from its walls.
These walls would nevertheless confine her in their midst from June let
the rigors of residency wrap her up like a cloud covering a blue mountain and
bathed daily in the interesting discussions that would take place over the
trolley carrying patient files, iv sets and spirit
cotton. Most of the machines in this high brow institute would have been
admitted for a major dysfunction, many a times life threatening (except the odd
one or two admissions catering to relatives of political leaders who kept
needling the consultants with their phone calls). June for the first time was
playing an active role in system trouble shooting. She was a registered
mechanic now, had the license to prescribe, input software programs that could
eliminate system bacteria, viruses, open up blocked pipes, flush out water from
the kidneys and very importantly be able to suppress the system's immune system
gone awry. She had the power and ability to decide which system required what
program (at least make urgent decisions at her level when her seniors or
consultants weren't around). 79 Piercing individual universes Things now
were quite different from her undergraduate days, where according to the system
prevailing all she did was read books and observe machines and their
afflictions evolving, hardly ever needing to take responsibility for any of
them. In MD residency she was responsible for the management of each of her
allotted machines, beginning with daily drawing samples for analyzing system
river data that would in turn reflect the functioning of each individual system
component. She also had to fix input-output (I/O) devices on to the body of her
systems allowing access to their rivers within. There were commercially made
small and large colorful IV cannulas that helped input drugs and fluids into
the systems along with gauging their central venous pressures. The latter was a
larger cannula inserted in bigger veins draining nearer to the central pump,
doing which was technically challenging and involved trying to scale a steep
reflex learning curve. Apart from assessing central venous pressures, the
machines had a lot more outputs to be analyzed like all the chemicals in its
fluid firmament dazzling brightly like molecules of countless stars. The only
way to really know the chemical compositions of these star constituents was to
delve into system-rivers, sampling them every morning with painful needles
sucking in blood and sending them to the lab in buckets full of test tubes. The
laboratory physician in his observatory would take readings throughout the day
from his spectroscope. These readings were from reflected light that bounce
back from the stars, blood molecules collected from pierced individual
universes. The residents would pounce on the evening reports as soon as they
arrived neatly attaching them on to their individual system file folders ready
for the evening senior residents rounds. June ran her eye quickly over the
reports of bed number 16. Sodium-140Meq, potassium-4.0Meq, Creatinine-1.2mg/dl,
albumin-4 g/dl...no major biochemical problems in this individual's universe,
the stars winked, another bed, another universe perhaps. Then there was
sampling that involved not just collecting water from placid normal rivers,
venous tributaries but also areas where there had been floods. Excess fluid in
the pleural cavity (a membranous bag covering the lungs and other pipes inside
the thorax) would necessitate a needle jab at the back of the chest. Similarly
fluid in the peritoneal cavity (the same membranous bag covering the
intestines, liver, kidneys etc) would need a poke in the abdomen. The rivers
around the spinal cord generators could be accessed with the same needle
devices requiring a bit more technical competence that June picked up easily,
having to practice the needling art in her daily voluminous sampling efforts
along with her colleagues. Some of them boasted of the ability to tap the spinal
fluid by throwing needles like darts from a distance aimed at the space between
the 3rd and 4rth lumbar spines on their patient’s backs. Then there were
needles that could sample bits of tissues from the individual's system
components. Needles biting off pieces from the liver, kidneys, pleura,
peritoneum, lymph nodes, gave a valuable peep into the microcosmic battles in
those individual component organs. In between her ward duties she would also be
posted in the casualty where her technical skills in establishing I/O access
devices would be honed further. She even learnt to effortlessly intubate
machines gasping for breath, thus helping to establish a vital airway
connecting patient system pipes to external mechanical lung pumping systems. Waiting for the Mountain June made
friends easily, only some of them were life-long. There was Rita who shared her
interest in poetry, birds and microcosmic system architecture. Their first
weekend trip was to Solan in Himachal where June saw mountains unlike the rock
outcrops she was used to in Sushunia. Rita told her about even loftier snow
clad ones visible from Shimla, a few more miles up and how they gradually
started getting bigger and bigger as you went towards them further ahead to Rikong Piyo, Kalpa
in Kinnaur. June had dreamed of them earlier during
her school days on listening to anecdotes at rock climbing excursions from
Samsara and his climbing friends who made yearly forays into those peaks. They
were average Bengali lower middle class tea cup intellectuals working in Govt
offices in Kolkata but once in the mountains they became transformed into
climbers, industrious and efficient in laying fixed ropes across difficult long
patches. June's diary, sept 01 There are
some people who never get to see a mountain. All they can do is simply wait. Any of these days it might just happen, flapping its
wings out of the blue would appear a shining desolate golden mountain and lift
them off their park side benches. icu-1)
Traumatic quadriparesis—Biceps brisk with fasciculations . CT Epidural hematoma compressing thecal sac.
Power improved to gr 2. ward1, Bimla's mother - PUO-sent off by me from OPD as viral…still
intermittent fever spikes. 2, 12/9/01,6:30PM-Prabha Sharma 22F-Fever with hypotension-admitted yesterday -CXR-showed Lt lower
zone consolidation...I added Crystalline penicillin…patient suddenly threw a seizure after having got crystalline penicillin although she
was all right…just a bit restless after the attack. It was her attendants who
were acting more hysterical and I had to shout at them and one point of time
while I was looking for a vein to give her diazepam and her husband was
muttering under his breath that we were continuing to experiment all sort of
medicines on her I just blew my top. I coolly kept the injection syringe back
in the table and said I won’t treat her and asked her to take her wherever he
wished. That changed him completely to the reverse and he started to apologize
profusely. After that we shifted her to the ICU and put in a CVP line for her
hypotension. The day one comes face to face with a huge
mountain, automatically windows open, deep down somewhere inside the brain. Dark
brown clouds atop a black massif penetrate your innermost corners and one fine
day they suddenly emerge barging into a busy office room full of overworked
colleagues. Flying in a magic carpet Residency
days were flying past quickly. June was having a great time. June's
diary Ward notes
Oct 21,2001 10:00 PM
Came back with Rita on a rickshaw after seeing a Bollywood
movie. The rickshaw puller allowed me to drive it myself on the deserted night
roads much to Rita's chagrin. I strongly
believe amidst us somewhere Resides a
gigantic mountain Full of
perennial snow Shining
brightly in the afternoon sun Changing
colors with time Morning…a
pinkish white Evening…a
orange hue We go about
all our lives Trying to
scale our individual mountains Somewhere
deep within them We
exist…ourselves Diary Entry made in a moving train A two-day respite, from a busy workplace… Retreat…to a bird-lovers paradise…A small and sleepy hamlet in
Rajasthan to which birds of all kinds of feathers flock. An intimidating
distance from our Institute and yet if our feathered friends can take all the
trouble to visit the place from more impressive distances, why can’t we…these
are some of the thoughts which tend to comfort me while I tremble and freeze
inside the Chattisgarh express as it tears its way
through a chilly Uttar Pradesh country side in the middle of a winter night. Bird billions, beeping tweeting whistling with the
river-tunes June’s
diary Next day I get down at Next Home
Unpublished novel for all interested in the science and fantasy of medicine. Not about religion, but a postmodern multi genre combining elements of Science, Fantasy and Romance |
