← The Secret Sauce
The Secret Sauce
The Doctor Every Indian Doctor Looks Up To Finally Speaks | Dr. Farokh E. Udwadia| Mukul Deora| E20
01:24:29
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A
Respected physician, a Padma Bhushan awardee. He has developed deeply unsettling view of what medicine has become.
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B
They've started to teach doctors empathy. How in the blazes can you teach empathy? You see, it is the mechanization of medicine and the hubris of its science and technology, which I think let medicine lose its power so that it submerges
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art at the altar of science. Doctors now, you know, they read the report and they give a diagnosis without even looking at the patient's face or touching them at all. Like Sherlock Holmes, you can see someone and you come up with something.
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B
Patient comes with chest pain. To me, she's been to the cardiologist and he says, I have to do an angio. I go into the personal history and I find that the poor girl has lost her father just a month ago. And that's the time when she started with the chest pain. Pain. You cure a disease in the body, but you left out the mind. Medicine is learned at the bedside, not in a classroom. You know, the patient is the doctor, the patient is your teacher. A really ill patient will make out a doctor who's genuinely concerned. It is only a good man who can become a good physician.
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A
A young woman who came to you with terrible insomnia and. And you prescribed music.
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B
Then she's been to a number of people, including psychiatrist. And wisely. After some time she says, I can't sleep, so I'm not taking. Then I asked her, I said, you like music? She says, yes, I like music. What's the music have you heard of? But you must listen it when you're in bed, when you're going to sleep. Amazingly, after three weeks, after I've started to sleep. This with magic.
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A
Wow. What is iatrogenesis?
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Illnesses made by the physician or the hospital. You do a procedure when you realize that the harm that can come if I do this procedure far outweighs the possible good.
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What is euthanasia exactly?
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When you know that the person is definitely dying, is going to die, and you are unnecessarily propping him up. It is often ruinous to the family. Unfortunately, the law states, for example, you have a person on a ventilator. You are not supposed to remove it, then it is an act of cruelty. I prepare myself every day for dying.
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You've told your son?
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Yes.
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That at any point I do not
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want any resuscitation today.
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Also, like if it happens, I have
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lived enough if my heart would have stopped. Well done.
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And do you believe everyone should say that? Dr. Farooq Udwadia has spent more than six decades at the front lines of medicine, pioneering critical care and being a master of diagnosis. In this episode, he reveals why some illnesses don't get treatment, what is wrong with the entire medical system today, and why saving a life isn't the same as healing a person. Okay, small pause. This is the part where I'm supposed to ask you to subscribe, but honestly only do it if you want more conversations that actually make you think. That's the whole point of the secret sauce. All right, back to it. So let's start from the. The beginning. You started practicing medicine in the 50s, in the late 50s, when India was such a new country. What did a hospital or a clinic look like then? Physically, emotionally?
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B
The hospital was very simple. For example, when I was, for example, a senior registrar at the KM Hospital, we had a ward, a male ward, which had about 20 patients at least, or 25 patients, sometimes patients lying in between beds on emergency days. Then one act, I had to look after a female ward also, which had about 10 or 12 beds. And I had to look after, would you believe it, a children's ward. There was no pediatrics at that time. Children. And also newborn big children. And that was a time which I was very, very, what should I say, anxious about, because I didn't know much about children, and particularly very young children, infants. So we used to manage all this.
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A
And you were then like 25 or something?
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B
No, I was much less than that, actually. I'll tell you how much. I was 23, 24, I did my MD in 25. I passed my MBBS in 22. So I was a TSAMS main registrar from 23, 24, 25.
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A
Wow. And just going back a bit. Doc, why did you choose medicine?
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Because I loved medicine from the very start. My dad was a general practitioner, right? He looked after the poorest of the poor. And on the dining table sometimes, you know, there was silence. And we would ask that, what's the matter? You're not speaking much today. And he would tell us about some person or the other was very ill and about whom he could do nothing, because nothing available in those days. So it was a conversation. And it was an urge within me that I should be a doctor. I always wanted to be a doctor. Right.
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A
You've been at Bridge Candy Hospital since 1964.
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B
That's right.
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A
Which is 62 years today. Most people, you know, change careers, cities, continents. What made you stay at beach Kennedy for 62 years?
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B
Well, that is a place where I was practicing, but it was not the Only place where I was practicing and it was there where I developed critical care.
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A
Yes.
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And it was this critical care which I introduced into this country.
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A
Could you tell us a little bit more about what is critical care and how you came about?
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B
It is looking after very ill people, not dying people. That's not what it should be though. Many people admit such patience. It's about very ill people, life threatening emergencies. Shall we put it this way? We look after them and try and get them right as best as we can. And when they are well enough, we discharge them into the ward bed. That's what critical care really is.
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A
So was that India's first icu?
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No, it was not India's first icu, but I started ICU in that hospital in a small room. Got it? You follow.
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Can you take us through how it was in those days to start an icu? You know what? Because where used to, everybody's seen.
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Oh, I started ICU in a small room in B North.
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Right.
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I had a nurse which was dedicated to that room. I had a doctor on call at that who would look after the ward. But pay particular attention to that room. I furnished that room with a proper monitor, with a primitive ventilator, whatever ventilator was available and whatever was necessary for emergency purposes. And I started from there and we saved some and we lost.
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A
Doc, you have said many times that medicine has lost its path, which is a pretty devastating statement for someone who's practiced it. You know, for someone like you to say when and why did medicine lose its path?
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You see, it is the mechanization of medicine, basically and the hubris of its science and technology, which I think led medicine lose its path so that it submerges art
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at the altar of science,
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submerged as art, and made it lose its raison d', etre, its essence, which is humanity, the human touch, which medicine is really so important about. So, so, so important, really. That's the reason why. So it's the mechanization of medicines, machines, gadgetry. I see more and more, more and more complicated, more and more important for many people. You follow and also see how great this mechanization is and see how clever it is,
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A
which is it's good in a way, technological advancement, but not at the expense of the human side of things. Because ultimately you're treating people, you are here to help people, not to show off.
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B
Not just to show off, it is for use and to help people, you know, to get people right by mechanisms and by machines which did not exist before. But at the same time, you Know all this at the expense of the human touch, right?
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A
Yes. You talk a lot about the human touch and, and bedside manner and how you can learn so much from spending time with the patient. You also said something very interesting that doctors now, you know, they read the report and they give a diagnosis without even looking at the patient's face or touching them at all, which has happened to me many times as well. So I want to talk a little bit about, about that. Udoc are the Sherlock Holmes of diagnosis. Everybody in India knows that like Sherlock Holmes you can see someone and of course you do a little touching and hearing and you know, all that stuff and you come up with something and then later they go for an X Ray or MRI and then they're like, oh my God, Dr. Odwadia was correct. I've heard this zillion times and, and you're smiling and you know it's true. Can you walk us through a case where, you know, a conversation and touching cracked? What you know, technology couldn't.
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B
Yes, I can tell you about this girl. I don't know, might, you might have read it about this girl who was brought to me by her employer. The girl was not keeping well. She was running fever, low grade fever. So I just chatted with her and I noticed she was rather sad looking and slightly withdrawn. So asked about numerous things which were completely not concerned with her illness at all. And then I just inquired very casually, what are your plans in the future? So this no really plan, I have to continue to work. And then just out of the blue I asked her, don't you want to get married? You're a prince. Pretty girl. She says, I cannot marry because I have to support my parents and they have no income. So you know what it is like in our country if you marry and have a husband who's separate and perhaps live in a joint family, how are you going to look after your parents? So I looked at the lady and said, this is sad. Are you, for example, you know, are the employer. Surely you can make things work in such a way that she gets a job or a place where she can earn much more and whether she can be married at the same time, perhaps her co parents. So the lady was quite astounded. He said, I'll try doctor, that's a good thing. I'll try. She did and it was a very happy ending. Later on I learned that she was married, she was happy, she had a good husband and she looked after her parents as well. And a Caesar's seizures stopped, fever stopped immediately. Because she managed to tell her what was bothering her, what was. What was killing her inside really.
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A
So she was fine.
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She was fine. It. Very often people run patients come to me with low grade fevers because of anxieties, frustrations, problems, stresses in life, mental things which manifest. Yes. And my. When I look at them and they all come with a last year of reports, I just said what's. What do you. I said throw that thermometer out of the window. That's my prescription for them. More often than not, I'm right. So it's very important to realize that you see medicine, you know, it's not just the body, it is a mind, it's a holistic affair. And there sometimes are problems in the mind which produce symptoms exactly mimic disease. But there is no disease. But symptoms mimic disease exactly as would happen with an organic health problem. And if you don't realize that, you know, you put the patient to unnecessary expense and you make them worse because you say, ah, yes, you have this, let's do this, let's do that, try this or try that injection.
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Just instead of spending time understanding the
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patient, you'll recover, but you require time.
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Yes.
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And you require the requirement experience to understand that perhaps there is something wrong, you know, which is upsetting this patient. A mental trauma which is upsetting the patient. Take an example for a patient I give you a class. Another classic example. Patient comes with chest pain. To me, she's mean to the cardiologist and he says I have to do an angio on your. I said why have you got this chest pain? How long have you had this chest For a month. I go into the details of the chest when I realize that it doesn't fit into a cardiac pain. Really I go into the personal history and I find that the poor girl has lost her father just a month ago. And that's the time when she started with the chest pain. So you really that this is what it is. So it's so important to realize that.
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A
And the card and the cardiologist will make him make it to 20 tests because he has.
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Yes. And then says I will do. And that happens all the time, Right,
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A
Doc, you said this very interesting thing I'm trying to quote you here. Clinical judgment is an intuitive gift which we cannot equate with intelligence or knowledge. And you said that sometimes a very knowledgeable and intelligent physician may have poor judgment, while ordinary physicians may be gifted with excellent judgment, which is an amazing, amazing thing to say. So what does someone do to gain this judgment? How do you build this intuition. I have studied well, I have tried to be a good doctor, but I don't have this judgment yet.
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B
I think, frankly, if you ask me, you either have it or you don't have it. That's the main thing, in my opinion. That's the main thing. You can perhaps improve your judgment with experience, you know, provided you take. Your experience teaches you and you don't just take the. Say, I've seen this, but you don't learn from it. So you can perhaps improve your judgment from experience. I think you might improve your judgment if you have. If you are aware of various other aspects of life. I honestly think so. Whether it's literature or poetry or religion or philosophy. The humanities. I think our knowledge of the humanities indeed makes a better human being better, Doctor. Unquestionably, I strongly feel that the answer is reason is very simple. I've been trying to understand why. What is medicine? It is, after all, the study of man. What is history? Also the study of man. What is philosophy? Also the study of man. So there are many outside things which impinge upon a human being and affect a human being. And if you have a greater awareness of those, I think you have a better awareness of. Of the human being you're looking at as a patient. That's the best way I can put it.
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A
And, and would you say one more important thing is compassion?
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B
Yes, of course. Compassion is. I think, yeah. I must tell you, one thing is, you know, empathy and compassion again are there. There are doctors who have it and there are some doctors who don't have it. And, and more so with the recent advances of science, with the mechanization of medicine, with the machines all around you, you're so filled with these machines that that aspect of medicine is forgotten. Can you believe it? I find it almost impossible nowadays. In the uk, they have started doctors, They've started to teach doctors empathy. How in the blazes can you teach empathy? Empathy has to be there in you. And if you try and say now you have to say this, or now you have to say that, it's all artificial, it's not coming from within, you know, it's all superficial. And a really ill patient can make that out. A really ill patient has literally antenna, just as a child has for his mother or a mother has for his child. A really ill patient will make out a doctor who's genuinely concerned, who genuinely has compassion and empathy compared to one we know who says something. But the patient will know that he's
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A
not genuinely concerned, just going through the motions.
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B
Yes, right.
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A
So Just basically there is no shortcut. You have to just kind of become a better human being that a more well rounded human being. And that will, because you're dealing with humans, that will help you kind of have a better relationship with your parent patients.
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B
Is a nice quote. It is only a good man who can become a good physician. This is not my thing. It's a quote.
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A
Yes, but being a good man is so hard. Or a good woman. Yes. You know doc, you spoke about the deep connection between the mind and body, which of course in the last 10 years everybody speaks about mind, body, mind body, that your mental things manifest themselves physically, physical things affect the mind. It's like a continuum. And you have been saying this for a while and you're not saying it as a self help guru, you're saying it as a clinical doctor. And you pointed to clinical trials where people get better on placebos because they believe in them. Could you tell us a little bit more about that and what does that mean about healing?
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B
You know, the mind body relationship is being researched upon a great deal now. There is no doubt about it that an actual physical illness can be colored by the mind. The way the mind reacts to it is, it can make the patient sometimes, you know, be blase, you know, I'm all right, I'm not. And also it may work the other way around. He may so exaggerate what he has. This becomes very difficult for the doctor. So the mind colors can color a patient's illness and the mind can produce clinical features which are indistinguishable from an actual illness. And it's so difficult therefore to realize that it is the, it is in the mind and not in the body. Sometimes you make a mistake. But if you are fairly experienced and you've seen a number of patients, you usually make out that here the mind is coloring his illness. So I must, I must keep that at the back of my mind or it's really actually the mind that has caused symptoms really produce features of an actual illness. So that's one way. Now how does the mind affect the body? That's the thing which there is a great deal of research on. The mind is affected in a patient who's ill by the equation with the doctor. So the doctor patient relationship, which unfortunately is being frayed because again because of the mechanization of medicine, the mind is affected in a way that if there is a good doctor patient relation bond between a doctor and a patient, particularly I'm not talking of coughs and colds, I'm talking of People who are really ill. This faith, the patient feels a bond with the doctor, he has faith with the doctor. Doctor, of course, tells me you're going to get well, don't worry. So it's faith. And faith, in my opinion, is a great healer.
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A
Could you give us an example, Doc, of or an anecdote of something like that where there was a patient all the time.
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B
It holds a time when a patient is hovering between life and death. If the doctor has a strong link with that patient and the doctor is compassionate, empathic and tells the patient, you're going to get well, it's going to take a little time, I'm sure you'll get well. The intelligent patient might ask questions and you have to answer them cleverly and you find that more often than that, you know, that works. But if you are blase, you just touch the patient, you know, good morning, good evening, I hope you've slept well. Etc. It makes a difference. Faith, therefore, is extremely important. How does faith work? You know, it's now been shown that there is a reason why faith works. Faith, you know, works on the mind. What part of the mind? Faith works on that part of the mind which controls the neuroendocrine apparatus. And the neuroendocrine apparatus which is present in the brain stem, brainstem very often is supposed to control or be a regulator of the patient's immune responses. So there is a reason, I mean, this is the current theory, how it works, it acts through the brain, it's believed that acts on that part of the brain which controls the patient's immune response. And if the immune response is good, obviously the patient gets better. So that's the current view. But that it acts, there is no question about. About it. Right.
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A
I read this story, Doc, of a young woman who came to you with terrible insomnia and nothing could fix it.
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Never forget that.
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A
And you prescribed music.
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B
Yeah.
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A
Could you tell us about that?
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B
Yeah, that, that was classic. She was in her 20s, I think, and she came looking quite harassed, the doctor. I haven't been able to sleep for weeks, six weeks, seven weeks. I, I just can't sleep, doctor. And then I again look into the story, etc. I don't find anything really in the mind, you know, not to find any stressful situation, nothing, you know, that I said. But surely you, you must be having some worrying that, you know, I promise you, doctor, I just, I just can't sleep then. She's been to a number of people, including psychiatrists, and they given all sorts of medications and wisely, after Some time since I can't sleep, so I'm not taking. Then I asked her a simple could you like music? She said, yes, I like music. I said, do you like English music, Indian music? He said, I like both, but I prefer English music. Said, what sort of Indian pop music are you fond of? Classical music? No, I don't like classical music. Have you heard classical music before? No, I have not heard classical music. I'm sorry. I'm trying to give you a piece of music which might work. How do you know it'll work? Because I've said this piece of music has been experimented upon in the United States. And they say that it helps people for some reason or the other who are anxious or can't sleep or whatever it is. So why don't you try it? After a pause. Okay, what's the music? Have you heard of Muzad? Yes, I've heard of. I'm prescribing this piece of music and I've done that to many patients just with this one Madzad clarinet. And I said, I'm hopeless with tech.
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A
Mozart's clarinet concerto. So I said, concerto can help you sleep. I'm going to try it tonight.
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B
And yes, I. But you must listen it. There's your full heart and soul. When you're in bed, when you're going to sleep all through. Then I explain what a concerto meant. There was a first moment which was at moderate pace. A second movement which is beautifully slow. Third movement, which is rapid. I explained what is a concerto. There's an orchestral people, you know, accompanying, but there will come a soloist. You will immediately recognize them. Sol, you can't miss that. So concentrate on that solace, every note that comes from. And she comes back, amazingly, after three weeks, after I've started to sleep. This with magic.
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A
Wow, that's.
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But believe you me, I. I've described this to many people, sick or not sick, and there's not one person who said that it hasn't made a. Made him or her feel a little better.
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A
Wow.
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B
It's amazing. And music has that effect again, it's on the mind. It's basically on the mind. Music acts on the mind,
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A
doc. You know, we use the word healing and the word curing as if they mean the same thing. But as you know, they are fundamentally different.
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B
Yes. You know, you cure a disease in the body, but you left out the mind. As I said, the mind colors everything. The disease itself, and therefore the disease may well be cured, but the mind may still remain uncured or unhealed. And it is that which is important and that it is the art of medicine which is able to do that. You must remember, you know, it has been beautifully. Describe the. I think it was Osler. Yes. It was Osler who said that medicine is an art based on science. That's a beautiful way of putting it. And he goes on further to say that the practice of medicine is. Consists of a deep medicine. Medicine consists of the uncertainty of science and the probability of art. The uncertainty of science, uncertainty of science and the probability of art. That's what he said and he's so right.
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A
I would think he would say the certainty of science.
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B
No uncertainty of science. Because science can be wrong. It's not certain. It changes. As you know, nothing remains stagnant in this world. The march of medicine is. The march of medicine is a chronicle of change. You know that.
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A
Yes.
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B
So you have a scientific fact which in 5, 7 years is modified completely or said this is wrong. That's why the uncertainty of science and the probability, again, the. That implies an uncertainty. When you say probable probability of art. That was beautifully put. Can I quote him further?
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A
Yes, of course, of course.
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B
He says another thing. Learn to see, learn to hear, learn to smell, learn to feel and know that you can only be perfect if you do that again and again. Medicine is learned at the bedside, not in a classroom. Do not learn the manifestations of disease from a person who lectures to you in a lecture room or even from a book you read. Learn to see first and then make up your mind. This is so beautiful. This is done in a time and at the age where there were no machines.
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A
Experiential knowledge.
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B
That's right. Basically saying, in other words, you know, the patient is your book.
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A
Right?
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B
The patient is your teacher. That's so true. There was no way otherwise.
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A
Amazing, amazing. There was. There's a word doc that I learned while researching for this podcast called iatrogenesis, which you speak about a lot. What is iatrogenesis?
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B
Yes, I cross is a Greek word physician. Genesis is to make so illnesses made by the physician or the hospital who's a further. But that happens all the time. This man who wrote this, mind you, I don't know if you heard of him, he's a professor of sociology in Mexico and he wrote this book called Medical Nemesis and he researched tremendously the best journals in medicine, peer reviewed journals, and noted the amount of damage, shall we say, or harm that can be done by medicine. He sort of was hooked on that and he proved by chapter and verse. See what I'm saying? This Is in this journal. This is in this show. It's true that medicine has. Can have a very good, ambitious impact. It also has a bad impact. And you need. For a doctor, you need to see whether it's likely to do more good or can do more harm before you do something, before you prescribe something, or whether you describe or prescribe a procedure. So that's extremely important.
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A
So he wrote this book about the harm that medicine can cause or does cause.
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B
No, yeah, yeah, yes, that's what I mean. You know, in fact, he comes to stay. First part of the statement is, I can't remember the exact word is to the effect that modern medicine has a fair amount of harm to meds, to man. That's his first borderless opening gambit, which really, you know, for. To any doctor, you know, that sounds outrageous because a medicine today, today, whatever you say, is the greatest benefactor of humankind. I'm quoting Porter, a great historian, medical historian, who says medicine is the greatest benefactor to humankind.
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A
Of course, look at the death rates
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B
all over the world. Everything, everything, everything. No question. And I'm sure the guy fell ill himself. You know, he would go to the best hospital or to the best doctor he knew. But he brings out a point, you know, that medical iatrogenesis is common. Procedures can do cause of harm, and therefore you need to take a balanced judgment what you're prescribing and what you're doing before you do it. Unquestionably, you know, there's a lot of iatrogenesis in medicine, and the greater the advance in medicine, the greater the medications used, the greater the procedures that come out. They all have a side effect which
- [33:59]
A
is harmful, which is often overlooked. You know, you said, doc, there's three types of iatrogenesis. If you could just tell us about each type with an example of each type to illustrate it better.
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B
Medical iatrogenesis, for example. You do unnecessary procedures when they are not warranted. You follow sometimes unwittingly and sometimes wittingly. You do a procedure, for example, when it is not warranted. You do a procedure when you realize that if I. The harm that can come if I do this procedure far outweighs the possible good. That's the whole thing. That's the medical attitude.
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A
And why would someone do that? Why would a doctor do that?
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B
Sometimes they do that for money. Sometimes they do it unwittingly. They do not realize you follow. Social arterageness is also very important. I'm bothered by people, you know, pestering for so many little things which they shouldn't really bother me about at all, but I have patience and I answer them for the smallest thing. You get a cold, why the hell do you want to go to a hospital and bother the doctor and tell the doctor, you know, cold, you treat it. You see, what I mean is the.
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A
Over medicalization. Yes.
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B
There is everyday life, tremendous over. Over medicalization, where society, people in society go to the doctor and particularly go to a hospital for something which is quite negligible. Sometimes, of course, you know, what may sound negligible may not be negligible. By and large, very often they go to doctors and to hospitals for something which is not required to. In other words, society becomes hopelessly dependent on the medical profession. Profession. Now that's very good for the medical profession, obviously, but it's not good for society. It's hopelessly dependent on that, and that's not good. And the cultural, of course, is very important. Cultural hydrogenesis, cultural iogenesis is that, you know, you want a person to be kept alive at any cost. I shall fight death to the bitter end, which is wrong because there are time and place. You say, this is enough, I'm not going to do this. What am I doing? I'm pro. I'm just prolonging a miserable life and prolonging the act of death. So that's now, now people are realizing, and now they say, I will not do. Even here, they realize it more and more. That is absurd to prolong the act of dying. It is torturesome to the patient and it is often ruinous to the family. So this is a culture.
- [36:54]
A
So would you say that generally we have become too dependent on. On medicine and hospitals and have forgotten family based care?
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B
Of course we have. Of course, yeah, we have family based case. My grandmother used to treat us. You have this, do this, you have a pain, I'll put a mustard plaster in your tummy, don't eat so many mangoes, that sort of thing.
- [37:16]
A
But do you think that still has
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B
value or do you think this value? For one thing, it's a great placebo, isn't it? This is good. My grandmother has said so. It has to be right.
- [37:31]
A
You know, in today's high pressure environment, the ratio is so low, doctors to patients. So what does integrity mean in today's commercial and high pressure environment?
- [37:45]
B
Integrity is very important. Integrity in relation to medicine, for example, means you put the patient before everything else. I mean, just. You mustn't talk of patients who come with cough symptoms and colds and all that. Those, you know, run of the mill things which practitioners that Even sometimes people have to deal with. I'm not talking patients, you know, who really require attention and who are ill. It means putting the patient before everything, before all else. Being honest and carrying integrity, which you practice in normal life and gentlemen practices a normal life into your professional life as well. Basically, that. That is the meaning of integrity. Not being moved by outside factors and not being conditioned, particularly by money. That is integrity. That is what my play is about.
- [38:55]
A
Yes, we're going to talk about your play, which I saw. I'm so happy I saw. The new one or the old one?
- [38:59]
B
Old one. Yes, there's a new one.
- [39:01]
A
I'm sure all your plays have integrity as well.
- [39:03]
B
Even more so.
- [39:04]
A
Even more so. And do you think young doctors today, coming out of all our colleges, are adequately prepared to face this storm of moral and ethical dilemmas?
- [39:17]
B
No, of course not. Ethics is taught in teaching college, but as a lecture, yes. Ethics should be taught by example. Here is a patient like this, like this. What decision are you going to take? That's the whole thing. It's not taught like that. I, on my rounds, try and do that, teach that as best as I possibly can. Right, but ethics is, you know, ethics. Ethics is. What is medical ethics, if I may ask? What would you call a medical. It's the. It's a moral obligations in the practice of medicine, moral obligations related to the practice of medicine that always brings into the question of good and bad, right and wrong, and the moral obligation that you have to do the right thing in medicine and not to do the wrong thing in medicine. But when you talk of medical ethics, you know, you can't have a universal code of ethics at all. For the simple reason that ethics is rooted in religious, philosophical, socio cultural conditions which vary in different parts of the world, in different communities and different countries. So you can't have a universal code of ethics, but the overall principle of right and wrong, good and evil, the respect for the sanctity of human life is common to all civilizations, all good civilizations, for sure, isn't it?
- [41:07]
A
Yes.
- [41:09]
B
And that you cannot debate. Sanctity for human life is so important. But that too is often sacrificed these days.
- [41:20]
A
Given all the pressures, how can a doctor remain compassionate without burning out emotionally?
- [41:26]
B
It's the opposite. It's exactly the opposite. It is compassion which keeps your heart going. It is compassion which helps you as a person, as an individual. You don't burn out, you burn brilliantly. More and more as you get along. You realize that compassion often indirectly includes love. And I personally think now that love is the Most important thing in this world. And it is that which is most lacking. Love permeates our world of living and love conquers all. But in today's world, it is sadly lacking. I am talking in general. Yes. So compassion really makes you a better human being in every way. You don't burn out at all. On the contrary, you will continue to burn better and longer.
- [42:30]
A
You have infinite.
- [42:31]
B
Yes.
- [42:32]
A
To give.
- [42:32]
B
Yes, yes. It's the ability to give of yourself which is so satisfying.
- [42:38]
A
Right?
- [42:38]
B
Which is the nice thing in medicine, believe you me, that you can help and you help for the sake of helping. For no ulterior reason.
- [42:52]
A
Let's just pause. Subscribing here isn't just about supporting our channel. It's about choosing what kind of thinking you want around you regularly. So if that resonates, you know what to do. In 2005, Doc, you co authored a study on how ICUs in Mumbai actually make end of life decisions. You know, when to withdraw treatment, when to let someone go. Such an important thing that you talk about. This is a subject that most Indian doctors will, you know publicly not talk about at all. What did that study teach you?
- [43:30]
B
That study taught me that when a person has a vegetative existence and when you are quite convinced that this is a vegetative existence which has no meaning, in other words, he is not living life at all in any way. And when I have taken also two or three opinions on that issue, say for example, the neurologist here is extremely important because it concerns the brain. It says, yes, he is absolutely vegetative. Life is useless. Then I have to explain to the relative concern, look, this is. So you are just prolonging the act of dying. And the act of dying maybe over weeks, in rare cases, even months or even longer. What would you have me do? Because believe you me, unfortunately the law states, for example, that you have a person on a ventilator. You are not supposed to remove it, but you will have to continue the ventilator for months and even for years on end. And the patient is an absolute vegetable.
- [44:50]
A
Is that what the law states?
- [44:51]
B
Huh?
- [44:52]
A
The law states that.
- [44:53]
B
The law states that you can't remove the ventilator except that you approach the High Court who appoints a panel of four people. And the four people say, yes, this is indeed so. Now you know if I. How long that would take? A year to do that probably, isn't it?
- [45:14]
A
Have you seen people approach the High Court?
- [45:16]
B
Yes. Yes, yes, yes, yes.
- [45:17]
A
And it's taken how long?
- [45:18]
B
A long time. I can't I don't remember it too long, it takes too long.
- [45:23]
A
The patient must have anyway passed, but suffered needlessly.
- [45:27]
B
Suffered needlessly.
- [45:29]
A
And what needs to change in the euthanasial laws, Doc?
- [45:31]
B
I think if the patient for all practical purposes has a vegetative existence, and the doctor is quite aware of that, and he has taken a couple of opinions to it, who important opinions, particularly from neurologists who say, yes, this is a vegetative existence, then perhaps it might be a good idea to not to prolong the active deaths and not prolong support in a patient like that. And this is the law by the way, in other countries? Yes, it's very much the law in other countries.
- [46:06]
A
And is this only for a ventilator or is there other situations?
- [46:10]
B
Everything else, for example, you're giving drugs to just prop up the pressure or if you're dreaming, giving feeds artificially. Even if you're giving feeds to a tube. The law state, their law states that you can even stop doing that.
- [46:27]
A
Any artificial method of prolonging, prolonging existence
- [46:32]
B
in a person who is in a hopeless vegetative state, in other words, who is not living life at all.
- [46:39]
A
Or terminals.
- [46:40]
B
Yes.
- [46:40]
A
Could not be vegetative.
- [46:42]
B
Yes, but terminal. Terminal meaning really terminal?
- [46:45]
A
Yes, yes, got it. What is euthanasia exactly?
- [46:55]
B
Euthanasia, Euthantos. It's derived from the word euthan toss. It's a Greek word, you know, which says kill. A good life must end. You know how they used to end good lives in those days? Are you aware of that? No, sir. Oh, it's beautiful. The Romans, for example, were very known for that. They used to lie in a hot tub and ask their slaves to open their veins. And they said it was the most glorious death you could have. It's a beautiful feeling as the blood oozed out when you're in a hot tub. That is one way. The other way, of course, you know euthanasia, for example, in battle, in battle a fellow is grievously wounded with his guts out. There's no way he could be brought to an ambulance or to hotel. He would beg and plead his colleague, please shoot me. And he would shoot him. There you are. That euthanasia, which is really practical, this particular in war is absolutely, absolutely done all the time.
- [48:11]
A
And at what point doctors, life prolonging treatment become an act of cruelty rather than care.
- [48:17]
B
That's when the patient, you know, is a vegetation, is a, is a vegetative existence, then it is an act of cruelty. Or when you know that the person is Definitely dying is going to die. And you are unnecessarily propping him up when you know this is useless.
- [48:36]
A
And what is the thing that you can write, do not DNS, do not resuscitate or something?
- [48:41]
B
Yes, of course. You do not resuscitate. If something. If, for example, my heart stops, I don't want to be resuscitated. I've said that to Zarish. Don't you dare try and do anything if our heart stops. Not even a cardiac massage. Let it stop.
- [48:56]
A
You've told your son.
- [48:57]
B
Yes.
- [48:58]
A
That at any point, I do not
- [49:00]
B
want any resuscitation today.
- [49:02]
A
Also, like, if it happens, under no
- [49:04]
B
circumstances would you do that.
- [49:07]
A
And do you believe everyone should say that?
- [49:09]
B
Sorry, no. That's up to each one's choice.
- [49:11]
A
Or at a certain age, maybe.
- [49:12]
B
Yeah, it depends upon a choice. A man at 90 who is fit, like me, in his 90s. I said, no, no, no, I want to live more. I don't want to. I've lived enough. If my heart would have stopped. Well done.
- [49:24]
A
Well done. Wow. Got it. So now, that's an interesting thought for people who are older, who are watching this, to know this point, that at a certain stage they can think about this point.
- [49:39]
B
Yes, of course.
- [49:41]
A
After they've, you know, lived their full life, whatever that full life means for them.
- [49:45]
B
If you write, you can put a living will, but if you tell a close relative, you know that, look, I don't want this done. Please don't do this to me. For example, when my father had a heart attack, he was in his 80s, he had a heart attack, and he had. On the second or the third day, he had an acute problem, which I knew was probably due to the rupture of the heart or some such thing, which there is no way of doing. Things got an arrest of that and said, all right, put in a tube. All right, just. Let's see. Do some cardiac compression. After 30 seconds, I said, stop, stop. I don't want this. Got it.
- [50:43]
A
To this point, what conversations can we have with the doctor? Can a family have with the doctor so our loved ones don't suffer at the end of their lives?
- [50:53]
B
That's the whole thing. You can make a living will now, which is quite.
- [50:57]
A
It's allowed.
- [50:57]
B
It's allowed now. It's allowed now. You can make proper living will in which you can state your likes and dislikes. You can state that you will not resuscitate me if my heart stops, or you will not do this or you will not do that.
- [51:15]
A
What else could Someone say in a living will. Dog, because you're the expert.
- [51:18]
B
I. You. You could say, if I'm ill, I don't want intravenous support where you have to support my blood pressure and all. I think I'm at an age where you would just let me die. Do what is you think is in your right common sense, but don't let me prolong life for nothing.
- [51:35]
A
You can write all that in a living. Yes, of course you can keep it quite open. Also, we are giving that decision to your loved ones, your family. So they have. Legally, you know, and morally.
- [51:46]
B
Yes, they are. Of course. Of course you can. You know, I don't know if you heard of. My daughter gave it to me some time ago. There's a comm. There's a group of doctors, you know, who give aid to. For killing people. Patient comes is so God's sake, I'm so miserable. I would like to die in Canada. In Canada, right. I forget the name is Physicians for Death or something. Medical Aid for Death or something. Maid or something to facilitate. Can you believe it? There is now a large group of doctors who only practice that. Only that. Only that. Going to people who say, I don't want to die and I don't want to live. Yeah. And. And going. So there you are. You lose the sanctity of life.
- [52:41]
A
Medical assistance in dying.
- [52:43]
B
Yes, Made. Yes, yes, Got it. You follow? So that's this. This is what can it can come to. Right. It's really dreadful because it's so easy, you know, and you're depressed and you feel ill and you have a long illness ahead of you to say, I don't want this, let me die. You, you're not. That means you are against the sanctity of human life. I told you, that is extreme.
- [53:10]
A
So they do it for people who are depressed also.
- [53:11]
B
So yes, they can. Very often. Very often. It's not just for physical ailments, it's also for mental ailments that they do that. And what is more, they go. I'm told that they go and ask people if you. If you're tired of living, just call as we. We'll do the needful.
- [53:28]
A
Like they're proactive.
- [53:29]
B
That's right, they're proactive.
- [53:30]
A
Which is quite dangerous.
- [53:31]
B
Which is dangerous.
- [53:32]
A
I'm surprised because I guess the main problem with euthanasia, I mean, the main. The main negative is that it can be misused.
- [53:40]
B
That's right.
- [53:41]
A
The positive is that it's. It helps a lot of people.
- [53:43]
B
Yeah, it'll come, you know, if you ask. Ask me about this. You see, of course, giving something to kill something is out, but giving something to assist him to kill something is also out. But supposing you have a patient who has immense pain and suffering. Sooner or later there will come a time when even in our place, where they will say, in such a situation, perhaps you can give him something, allows him to die. But there are major questions on this. The reason for saying this, you're doing something which is beneficient and beneficial is one of the first principles of ethics. Doing good to the patient, relieving him of suffering. Beneficial. That is the first principle in medicine, the most important. And aren't you being beneficial by ridiculing him of this immense pain and misery that he has? But you know, there is a border. Who's going to police that border between a beneficial act and an act which does a lot of harm. Yes, isn't it? Particularly in our part of the world.
- [55:08]
A
Yeah.
- [55:09]
B
You know, you could influence a very ill person, of course, isn't it? Look, he's got three flats there. We can. He's wanting to die. Let him go. Let him.
- [55:20]
A
We get the three flats.
- [55:21]
B
You know what I mean? This is what is the most important thing.
- [55:24]
A
Very hard to police.
- [55:25]
B
Yeah. And then, you know, it's another very important. You know, if you start that you might become a. It might become a cult. I'm old, I mean firm. They are all unnecessarily harassing, being harassed by me. Might. It might become a cult, that this is the time to go, let me go down.
- [55:43]
A
And, and, and it could lead to a case where even children of their parents who are greedy or, you know, they don't have a good relationship, like you said, they, they'll harass them so much.
- [55:53]
B
Yes.
- [55:54]
A
That they will willingly say, let me
- [55:55]
B
die, let me die.
- [55:56]
A
And now there's a method to kill you.
- [55:58]
B
Yes, you. And then there's a. You know, it's. You say you are beneficial because you want to relieve suffering, isn't it? But I ask you, can you measure suffering? There are people who have such moral courage, you know, that they bear their suffering very well. And there are others who have nothing very much but say, this is unbearable. How can you measure suffering?
- [56:26]
A
It's very personal and surprising.
- [56:27]
B
It's a very personal thing. And when you make a legal issue out of it, you have to remember that is the benefit that would accrue clearly outbalance the harm that can be done if you make it a legal sanction.
- [56:43]
A
Right.
- [56:44]
B
Isn't it? Is the benefit Going to outwit a possible harm in spite of all the protective things that you might put into place.
- [56:53]
A
Right, Doc? In your book Tabiyat, your final essay is titled Death. Why did you choose that as the final essay?
- [57:05]
B
Because the only certainty in life is death, isn't it? The only certainty? There's nothing as certain in life as death. Can you find anything as certain? Nothing. This is the only certainty in death.
- [57:21]
A
And yet we run away from it.
- [57:23]
B
Yes, but you have to prepare. For example, me, I prepare myself every day or die.
- [57:29]
A
How do you do that, Doc?
- [57:30]
B
Just preparing myself. Ready.
- [57:32]
A
Mentally?
- [57:33]
B
Yes, mentally ready. I don't know when actually whether it comes I have been successful or not. Time only will tell there.
- [57:42]
A
But how does one prepare themselves, Doctor?
- [57:44]
B
Yes, that is. You know, it's inevitable that I've lived so long. I've just been so happy in every way. At home, outside, professionally. In every way. But there's a time to go. Nothing lasts forever.
- [58:00]
A
But you need a lot of strength.
- [58:01]
B
Nothing lasts forever. Nothing lasts forever. Nothing. But. But nothing lasts forever. That's the thing. Do you think, for example, Flemings is going to be remembered after 2000 years from now? No. Nothing will ask forever. Everything goes. I'm Zimandius, king of kings. Look on my works, ye mighty, and despair. Nothing remains of it. This is a man who's written by. I think it's Sheni Horan, Ozymandias.
- [58:37]
A
Everything must pass.
- [58:38]
B
Yes, everything is gone. Where is my huge kingdom? I am this, the sand of the desert that is left from beginning to end. That's what he says. Right.
- [58:50]
A
There's a beautiful song by Coldplay, which is a new band. I'll send it to you. And it's. It's. It's called Vivala Vida. And it's. He saw the singer, saw this photo of the French Revolution, you know, of this war and everything. And he made this song where he was kind of the king. And he says, I used to rule the world. Seas would rise when I gave the word. But now I sleep alone, Sweep the streets that I used to roam. And he says, all my castles are now pillars of salt and pillars of sand.
- [59:24]
B
That's exactly. I am king of queens. Look on my works, ye mighty, you mighty. And despair, nothing of it remains. That's it.
- [59:36]
A
When do you think is the right time to start accepting the inevitability of death?
- [59:44]
B
A young person thinks he's so far away, so far away. Why should I think about it? But as you grow older, you realize the inevitability of it or if you are very ill and you realize that you may die, then you realize myself. Otherwise you think it's so.
- [60:06]
A
You think you live forever.
- [60:07]
B
It's yes. You think the death is walking besides you, and he lets you walk wherever you want. But one fine day he'd hold your hand and say, chum, you have to follow me now. So it must be prepared to follow.
- [60:22]
A
And do you? Do you. What do you think happens when one. When one dies?
- [60:27]
B
Such a difficult place. Question. Nobody's come back to tell you that. Yeah. I think you know that physically the body just nourishes the earth whichever way you want to go, isn't it?
- [60:46]
A
Yes.
- [60:47]
B
But I do believe that there is a spirit within you. Why do I believe that? I can't tell you why. I believe that perhaps I am influenced by the great sages of the world who say that also. Perhaps it's an intuitive field that can everything be finished and complete. My personal belief is the spirit goes and merges into the universal spirit. And the sad part of it is, therefore you will not be able to make out who is who. That's the only sad part.
- [61:24]
A
Your identity is merged.
- [61:26]
B
Yes. You can't make out, for example, your wife or your children or anyone at all. It's just one spirit, the whole spirit now that questions you. What is. Who is God? Now I ask you that question. Who do you think is God? Who's God? It's not a man, obviously. Not a woman, not a man. What is it? It's the foresight. It's a force which is knowledgeable for some reason or the other. It's knowledgeable. It's a force that conducts the world, the universe, not the world. And rubbish. Nothing of the sort is nothing. But I hate to believe that.
- [62:07]
A
Faith.
- [62:08]
B
Yes. I hate to believe that. Yes,
- [62:12]
A
doc, you are 94. Going to 95. You climbed seven flights of stairs.
- [62:17]
B
Not now. I did. That journey doesn't allow me to climb. I sometimes climb surreptitiously.
- [62:26]
A
He doesn't lie. Everybody talks about longevity these days. Longevity or healthy lives, you know, living. I think everybody watching this is dream would be honestly documented to live the way you have lived till this stage of your life, which with such amazing strength, vigor, vitality that you have. Now, the obvious question is, you know what I'm supposed to ask you from this is what is your formula? But I would just say, what are your thoughts that we can take from you on. On how to live a life one half as great as yours?
- [63:10]
B
I think I can tell you. Longevity is Dependent on your gene. And it is a gene which very often overwhelms other contradictory. For example, I've known people who had cancer and would normally not last it long, but they have the gene of longevity in them so that they last much longer than they would rather otherwise have done. That's one thing. And the other thing is, I think, I don't know, it's your way of living which is important more than anything. You can't change your gene. You have, for example, a 35 year old individual who has a gene from his father, from his mother, from his grandfather, grandmother, uncles, aunts of heart disease, of a thrombosis, of coronary artery disease, disease, whatever they do in their life. He gets a heart attack, however, well, he's with his food, his diet, his exercise, you name it. But the gene conquers all here. But basically, I think a good life means for one thing, you have a purpose of doing something which you want to do and which you're interested in. Perhaps helping others is one thing, perhaps being righteous. Being righteous for the sake of righteousness and not for the sake of any other ulterior motive, that's one other thing. And being loving, that's very important. You can always be loving. I mean, you can't love somebody you don't know. But you love people who are close to you, for example. And as a doctor, you as compassion and empathy, it includes love underlying. That is always love, isn't it?
- [65:03]
A
Yes.
- [65:04]
B
Then, at least in my religion, good thoughts, good words.
- [65:09]
A
Yes.
- [65:10]
B
Good deeds. You know that. I know now, good words and good deeds are always possible. But good thought, we have to be a saint to be always having good thoughts. Yeah, correct. And I'm a saint.
- [65:23]
A
You have to try.
- [65:24]
B
Yes, you could try, but I'm no saint.
- [65:26]
A
I, I try. You know, Doc, every morning I wake up and for the last six months I've been doing it and I tell myself, I ask myself this. There's a guy called Tony Robbins, this is what he, he said to do. And I asked myself, what are you most happy about in your life right now? And it takes some time to, you know, in your mind because you're so used to thinking whatever you want to think when you wake up. And then you come up with what's happy, what makes you happy at that point in your life? And then he says, why are you happy about that? And how does that make you feel? So you go in and you feel how that makes you feel. And then you do the same thing. For what are you most proud about? In your life, what are you most grateful about in your life? What are you most excited about in your life? And then, and then he says, who do you love and who loves you? And if you do that every morning, like you said, that good thoughts bit really comes in from the beginning of the day and you realize that there's so much, there's so much that you have and then you can give something you have to give, you know, otherwise you just get up thinking you don't have anything or whatever nonsense you have in your head.
- [66:30]
B
Good point, good way of looking at things.
- [66:34]
A
It's so interesting, doc, that when you spoke about what your, your tips and tricks for a, a good life, all the things you said were mental while we spend so much time on the physical as well, which is, you know, exercising more, walking more, having multivitamins, biohacking this vitamin juice, this powder, this, this, this, this. What do you think of all those things?
- [66:58]
B
I don't think they're really worth it. If you have a balanced diet, that's enough. It gives you, you can take a vitamin if you like because you may perhaps be lacking in something or the other. And you need some exercise, of course, and you need, you, you mustn't overeat. You must exercise. From that point of view, from the health point of view, the less you eat, I think, the better it is as you grow older and you need some exercise. And as you grow older, the best exercise is just walking.
- [67:31]
A
I see.
- [67:32]
B
If you walk every day from, you
- [67:34]
A
know, people are doing high intensity training
- [67:36]
B
at 50, it's all rubbish. Doesn't add to good health at all.
- [67:40]
A
It doesn't.
- [67:41]
B
They think it's going to make them live longer. Maybe it'll make them live shorter, but not longer really, because if you do all this high, sooner or later you'll sprain a ligament or tear a ligament or tear a cartilage or something or the other. As long as you walk every single day, take fresh air, you, you have walking, you have jogging, you have running and you have swimming. These are the natural exercises that God has given you, which you can do. And if you do, though, you see, a good champion swimmer is fantastically fit and he doesn't have rippling muscles like those who lift weights.
- [68:19]
A
And yoga.
- [68:20]
B
Yoga is excellent because yoga is for the mind.
- [68:25]
A
Mind and body. Yes.
- [68:26]
B
The body remaining supple.
- [68:28]
A
Right.
- [68:30]
B
And the mind remaining tranquil.
- [68:32]
A
Tranquil, yes. And talking about nourishing your soul, you are a man, you're a Renaissance man, I think, which a lot of people don't know you paint. I've seen your paintings. They're fantastic.
- [68:45]
B
Come and buy them, please.
- [68:47]
A
I'm waiting for your exhibition.
- [68:48]
B
I don't know when they're going to go.
- [68:50]
A
You should talk to Mr. Pandol soon.
- [68:51]
B
Yes, I'm going to talk to him now.
- [68:53]
A
And you play the violin, which is something I know you love classical music, but you play the violin. And of course you are a writer of books and of plays. You had a play, which I was fortunate to. To see. So how important is, as you call it, nourishing your soul, doing things for expression, for joy. How important is that?
- [69:17]
B
It's very important. That's why I say a knowledge of the humanities is so important. It makes a better physician. It humanizes myths.
- [69:27]
A
Let's put it so one part of it is for a physician. But you're also saying that it's. How important is it for just to. To live a better life?
- [69:34]
B
Yes, of course it is. Because, you know, you. You. You diversify yourself and then you enrich yourself. And that enrichment helps me in my profession also. That's the other thing I think. It enriches me. Right. In my profession.
- [69:50]
A
Right. And it'll enrich everyone in anything they do, basically.
- [69:53]
B
Exactly.
- [69:54]
A
To have these layers. Talking about the medical profession now, Doc, you know, now it takes longer and longer to become a doctor and demands more sacrifice than ever. Is it still worth choosing to be a doctor?
- [70:08]
B
You can. You should only be a doctor if you have a. In. In innate desire and ambition within you to be a doctor. But this unfortunate point is many people are forced into doctoring by their parents. This is a good thing, of course. It's very good. It's very reputable. And it gives you lots of money. Yeah, that's the whole thing.
- [70:29]
A
Especially if your parents are doctors also.
- [70:31]
B
Especially if your parents are doctors. So it's very wise not to do that.
- [70:35]
A
Right.
- [70:36]
B
Let them make their own choice. And only one who's really into interest in helping people. Yes. Medicine has so many pock marks. Like, you know, smallpox leaving marks on your face. There's just so many pock marks. First of all, the lack of humanity today. The second thing is the commercialization of medicine. So it's become a business is no longer a profession.
- [70:58]
A
Right.
- [70:59]
B
And a nefarious business at that. Imagine, for example, patients being passed from one country, consultant the other. Not for the benefit of the patient, but benefit of the doctors.
- [71:10]
A
That happens, of course.
- [71:11]
B
It happens all the time. It happens all the time. Or having this cut practice, which is sort of almost tanker Cancer, I would say, in the heart of medicine today.
- [71:24]
A
What is it? The cut practice.
- [71:26]
B
Cut practice. You send a patient to the consulting, gives you something, a cut from it. Right, That's. This is so good. A bit of my rounds, you know, are influencing young minds to behave ethically. And I say the future of medicine is not in the hands of old people. Older people. Yeah, it's in your hands. It's for you to take up the banner and practice medicine as it should be practiced. It is you. For you to change the bad into the good. Right?
- [72:03]
A
And talking about, you know, consultants and specialists. You trained in an era doc, where the GP was central to healthcare and you are the. The. The king of gps. I know you. You'll hate me for saying that. Why is the GP disappearing in India?
- [72:18]
B
Because there are so many specialities. Everybody wants to become a specialty, right? Everyone wants to become a specialist.
- [72:25]
A
Right?
- [72:26]
B
But the specialist is at a great disadvantage. Once upon a time, when specialties were formed, I was there learning and working. The specialist, believe you me, had a large ward of general medicine and six beds for his specialty. Very researched and worked. Today the specialist basically does only a specialty and therefore he's at a great disadvantage. If you go, for example, to a person who's a GI person and tell him I have a tummy ache, he'll put a scope of you from above and also from below. Yes, I know you understand, Okay?
- [73:13]
A
I know exactly what you're saying.
- [73:14]
B
If you go to a person who is a cardiologist. There are good cardiologists, of course, but it's not uncommon for the cardiologist to straight away advise you to get a coronary art feed and you done or something or the other like that, you know? For example, a patient who comes with abdominal pain, the problem might die in his lung and not his abdominal. A patient who has, I can't pass urine properly, I'm retaining urine in the bladder. And he goes to a urologist, gives him and perhaps removes his prostate. The problem might lie in the fact that there's a problem in the nervous system. You see the point? So there's a. Who wouldn't want a special. Suppose I had a tear in the Regina. I certainly would go to a person who knows and specializes, isn't it? Or a person who has a cancer in the lung and leshes operation. I would certainly go to a person who is doing this all the time. Correct? But at the same time there are great disadvantages.
- [74:21]
A
And so then, therefore, what kind of doctor does India need more of today?
- [74:29]
B
Certainly requires more people who have a holistic idea, you know, and consultants also perhaps who know that medicine, that there is an art to medicine as well. What is the art to medicine? What is the more. How would you translate? Besides of course, the art of history, the art of examination. How would I define I, I, you know, I've thought of this. How would I define that? You say it's mind and body qualities which you cannot really describe, etc. Etc. I think it's the artful application of its science to the holistic care of the patient that's the way of defining.
- [75:21]
A
Right. Doc, what worries you most about the future of the medical profession in India today?
- [75:28]
B
My worry is the human touch and humanity is going to be increasingly lost as you advance further and further in science and technology. My worry is that you will be practicing with a machine rather than with a human being. The machine will be the go between you and the patient. And the worry is you will also make the patient think more of the machine than of the doctor. Right, Basically.
- [76:12]
A
And what gives you hope when you see the next generation of doctors? You're teaching so many doctors every day.
- [76:19]
B
My hope is that they realize that medicine is an altruistic profession, that the patient comes first, and that humanity and compassion must go hand in hand with your science.
- [76:41]
A
Doc, you've quoted Maimonides, a philosopher physician from centuries ago, who said that we should never see a patient as merely a vessel filled with disease. In the world of MRIs, blood panels, AI diagnostics, what is a patient if not a collection of data points?
- [77:00]
B
Oh, he's a collection of emotions, feelings. He's a person who has thoughts. You know, he has. He's a person who is conditioned by his environment, his genes, his constitution, his strength, physical, emotional mentor. I see all of that. And not just the disease. That's the whole thing. That's the meaning of holistic approach, that you see the human being as such. His mind and his body and everything that impatiences.
- [77:33]
A
Right. The human, the person that's there, not
- [77:37]
B
just the, not just the disease. You're not treating the disease, you're treating the patient.
- [77:42]
A
Right? Doc, you had written a play about a man called Dr. Schweitzer, who's a Nobel Prize winning doctor in the 20th century, who, who saved countless lives in Africa, a European man who kept coming back to Africa and he was a poor man and, and about his journey to Africa and how he saved lives.
- [78:06]
B
I'm just trying to say, you know, I'm giving you an example of probably the greatest human being There was in the the 20th century, not Einstein, it was this man. Why? Because he gave love, in a way, in a practical way, he gave love to people who required it the most. So he was a poor man, but he got admission into the one of the most elite colleges which ordinarily admitted only progeny of nobles and great people, doctors, dukes, etc, and it went through an interview and you had to pass the theology exam to be admitted. But if he failed the theology exam, can you believe it?
- [78:57]
A
Right.
- [78:58]
B
But he did brilliantly in others, and he did brilliantly, particularly in history. The history professor was astonished that a young person like that knows so much history. So he tells the theology professor, I'm sorry, this is the rule of the hospital, this university, where there are exceptions, and he's going to be an exception. And at the age of 24 or 25, he was a doctorate in music, he was a doctorate in theology, he was a doctorate in philosophy and one other thing. And he was a champion organist, the best organist in that time. But at the age of 30, he said, I must give back to the world. I have been so fortunate. I was a poor man and I'm so fortunate. So then he goes, dust.
- [79:53]
A
Amazing.
- [79:57]
B
He won every prize that was to be won that the world could give him, including the Nobel Prize, of course.
- [80:02]
A
Oh, he won the Nobel Prize, yes, of course.
- [80:04]
B
And every other prize, the Goethe Prize, would you name it?
- [80:07]
A
For his work in Africa.
- [80:08]
B
For his work. But he would go back to Africa when he was short of funds, he would go back to Europe, give recitals on the organ, gather the money and go back. And it's amazing, it, you know, that when he would play in the middle of the night to soothe himself, the Africans would gather around his bungalow and onto his balcony to listen to him.
- [80:30]
A
Amazing. Of all the poets and writers you love, Hugo, Somerset, Maugham, Tagore. It's T.S. eliot we keep coming back to. And you said something very beautiful that he finds. He writes about finding purpose in the wreckage of despair. Such a beautiful line. It, you know, brings so much, so many images in my mind. You have seen so many people come and go. What does Elliot understand about the human experience that a medical textbook cannot teach you?
- [81:07]
B
I think, you know, poets and artists are forerunners of the future, you see. So when he describes, you know, after the First World War. Well, after the First World War, shall I quote what you.
- [81:23]
A
Of course, Elliot, yes.
- [81:24]
B
He says, what are the roots that clutch? What branches grew out of this stony rubbish? Son of man? You cannot say or guess or you Know only a heap of broken images. Where the sun beats the dead tree gives no shelter and stone no sound of water. Come into the shadow of this red rock and I shall show you something which you do not know. Your shadow in the morning chasing behind you. And the shadow in the evening rising to meet you. I shall show you fear in a handful of dust. So he sees, he projects what the world has come to. And he also. The future of the world as that is right now. Beautiful, isn't it?
- [82:28]
A
I know.
- [82:29]
B
You know, you.
- [82:30]
A
When you said this poem. You know, I love Bob Dylan and he. He loves Elliot. And I heard bits in it which. Which Bob Dylan has put in Tambourine man actually, about.
- [82:39]
B
Really?
- [82:39]
A
Yeah, yeah. Like the line you said. I was just. I can't remember what it was, but the shadow, the shadows. The shadows chasing. The line you said about the shadows chasing the. In the day the shadow chases you and in the night.
- [82:54]
B
That's from Elliot.
- [82:55]
A
Yeah, No, I know, but Bob Dylan got inspired by that in Tamborine man, you know, 100 years later or whatever. It was beautiful.
- [83:02]
B
And.
- [83:02]
A
And the thing about dust in your hand sounds a lot like William Blake.
- [83:06]
B
Yeah.
- [83:06]
A
Another great poet as well. Doc, be beyond all the awards and recognition that you rightfully have and deserved, what do you hope truly lasts from your life's work?
- [83:19]
B
Yeah, I hope I get equanimity.
- [83:25]
A
You're still working on it?
- [83:27]
B
Yes.
- [83:27]
A
You have to always work on it.
- [83:28]
B
You always work on accountability.
- [83:32]
A
If anyone listens to this conversation, years from today, what would you hope stays with them?
- [83:38]
B
You tell me that.
- [83:39]
A
It's a very good question. Let me. Let me. I like that. Put me on the spot. I can only. I know what I mean. There's so many things that will stay with them. I think just hearing you talk about all the different things, hearing you talk about life, about death, you know, equal. It's like, who said that success and failure are both imposters? In. In that way, even life and death are both twins, you know, And. And we celebrate life, but we don't celebrate death. But. But hearing you, I see that. That. That you have to look at both, you know, not equally, but they both are such important things. One is inevitable and one is where you are today. So I think I. I think that's what I learned.
- [84:23]
B
Well done.
- [84:24]
A
I passed the test.
- [84:28]
B
That.
- [84:28]
A
That. That gives me happiness.