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Monday, September 20, 2010


( An invit piece which was written on the occasion of a seminar/ conference on Cardiology at Patna. The death of a friend recently gave it an immediacy, which I had not felt when I scribbled it in a lighter vein.)

    Posthumous  shame is likely to be heaped  on those those who die of heart attack . Only if they had taken enough precaution, they could have kept their deaths  at bay. Preventive heart care is attracting eager converts to its fold. Seminal to the dogma is the assumption that the heart is intrinsically unreliable and fickle. One shouldn't trust ones heart-not only in amorous matters but in the simple physiological sense of the term as well. It is essentially delicate and fragile; vulnerable to a hundred influences from our own mental landscapes as well as from the external environment.  If you are forty ( better still if you are thirty five) it, needs to be kept under constant surveillance. Abnormal heart sounds may indicate enlargement of heart; bifid impulse is the harbinger of evil tidings.Not seeing your doctor  will seriously jeopardise your chances of survival. There are no atheists or agnostics now. Few can ignore a chest pain, or palpitation or shortness of breath. Flatulence can scare most of us with intimations of disaster. The spell is inescapable.

Heart foundations are propagating the new religion of heart care with as much zeal, and ardour as the proselytizers ever did. In our time everyone-from policemen to politicians, from doctors to dream-merchants, from stock brokers to surrogate mothers- just about everyone, is believed to have a heart apiece, despite the compelling evidence of the heartlessness of many of them! People who   are overweight  they are living a state of sin and their hearts are in mortal danger of being claimed by the devil. Djuana Barnes sounded the alarm bells when she said, 'We are adhering to life now with our last muscle -the heart."

The sickness of the heart we are told is caused by our personal life style, (diet, activity, addictions etc.) and the harmful things in the personal environment. The classical medical wisdom that disease is the result of infringement of natural laws has come full circle. "Diet" says Deepak Chopra M.D, oncologist turned T.M exponent, "is destiny". (Revising Freud's dictum "Anatomy is destiny".) .To buttresses his point he enlists the authority of the Taittereya Upanishad. No less!

"Dost thou think because thou art virtuous, there shalt be no more cakes and ale?" asks a Shakespearean character rhetorically, to which the answer of the virtuous must be a firm and unambiguous, "Indeed, there shall be no more cakes and ale". Cholesterol, rich food, red meats, ice creams, condiments and cookies, in short whatever tickles your palate are temptations placed in your way by the devil himself to which the standard response should be the upanishadic Neti, Neti (Not this, not this).

Salvation lies in plain salads, sprouted beans, and frugal diets. When it comes to eating, altruism is the best policy; charity a strategy of survival. Eat the lean portion yourself, and give the succulent bits to your neighbor (especially, if you covet his wife!) The yolk of the egg, the fat in the milk, they are all dispensable and deserve to be gifted away- to your enemies! Traditionally men have sought the solution to their nagging problems at the bottom of a bottle. The standard excuse given by tobacco addicts is that they try to smoke away their worries. Some relaxation may be given in case of alcohol and one may imbibe it occasionally-preferably under medical supervision- but smoking is absolute blasphemy. If things get too tensed up, well! swallow an Alprazolam. But I find the stunning piece of wisdom offered by the once stunningly beautiful Brooke Shields more comforting. "Smoking kills" she says "If you are killed, you have lost a very important part of your life".

The narrow and straight path in the new ecumenical faith leads to the gymnasium’ and aerobic clubs, swimming pools and jogging tracks. The third commandment requires you to renounce the comfort and the warmth of your blanket in a cold winter morning, get into your sneakers and track suits and head straight for the Sanjay Gandhi Biological Park or some such place. Five days a week, through fog or rain hell or high-water; all the year round.

There are some more prohibitions and one wonders, whether it is the heart which is at the centre of the doctor’s concern  or is he bent upon turning us all into saints. Late night bridge parties are to be abhorred; instead pranayam and yogic postures are to be practiced early morning, behind closed doors or better still in the open. Meditation is chicken soup for the soul, all right, but it is even better for your blood pressure and your heart. Viipasana and Yog Nidra have been appropriated as therapeutic tool for idiopathic angina. In fact there is a whole ritual no less esoteric than that of a holy anchorite who has renounced the world. The devout of this sect are to be seen walking on spiked sandals, clapping their hands away to no purpose, or laughing away to glory, under the banyan tree in the local zoo.

The most important ritual of the cardiological rite, however, is  the routine checkup, for those who want to keep their body and heart together. A consultation with your doctor assumes the gravity of a confessional session. Alone with your doctor you are prepared to reveal all, in a mood of repentance and tell-all. Through percussion and palpation he prizes out the rest of the secrets out of your heart. His stethoscope probes it from every conceivable angle. You are wired to the ECG machine; you jog on the treadmill. Meanwhile you keep confessing, uninterrupted, a long list of mea culpa.

"Doctor actually I overindulged myself during the last couple of days. I have been smoking lot lately as I am going through very difficult times". “I was spotted with a women friend in the club by a common acquaintance. Had a row at home. That is when I felt a stabbing pain in my chest, on the left side". And so on. The list of woes is endless. The cardiologist, like a kindly priest presides at the confessional and listens with amused detachment. He is indulgent towards these fallen souls. He knows the way of all flesh and reassures the patients, and asks them to be good and responsible.

But there may be greater peril lying in store-the judgment may be severe. The man in white may pronounce with appropriate gravity the condition to be tricuspid regurgitation, peripartum cardi-omyopathy or heart valve pulmonary stenosis or some other disease with equally sinister name. It falls on the affected victim and his family like a tonne of bricks. The sinister sounding name kills before the disease does. The cardio thoracic surgeons, especially, those who perform the critical suture are to their profession what the aviators (not mere pilots!) are to the vocation of flying- the elite of an elitist club. What they love best is finding excuses for performing the cardiac bypass surgery. In a consummate display of their skill they saw you down and then sew you up, as a tribute to their Olympian gods like Christian Bernard Denton Cooley and others.

But "The heart has its reasons", as Blaise Pascal said (or was it Emerson?)" that reason does not know" and ever so often confusing evidence keeps turning up which inspires skepticism even fatalism in the humble uninitiated fold. This heretic has broken all the commandments, flouted all the injunctions of the sacred text. He is a doctor himself (was, alas! he is no more. Death claimed him in his late nineties and certainly the heart was not the culprit. ) around ninety, already and has ambitious projects up his sleeves. A lover of good food he can eat his breakfast, lunch or dinner at anytime of the day-and several times, at that. His dinners are invariably washed down with copious amounts of good whisky and he gave up smoking out of sheer fatigue and boredom rather than in deference to the prevailing orthodoxy. If ever there was a convincing rebuttal to prevailing orthodoxy, it is him.

And this friend of mine. Forty-eight, athletic and young, lived his life by the book. Almost like Rousseau’s noble savage. Definitely not the type A personality. He died on way to airport of a massive heart attack. The chauffeur discovered him, dead as a dodo, at the airport, in the back seat of the car. I was told there was a frozen look of mild surprise on his face.What had he done to deserve this? Milton though blind, justified the ways of God to men in unreadable and boring poetic texts. The cardiologists, however, were not at a loss for explanation.It seems that he had a genetic predisposition. Was born of the wrong sort of parents.So there you are. You cannot trust your heart. NEVER!


Dr Vijay Kumar Gupta said...

Beautifully written article Manojeji, being a doctor and dealing with heart everyday, I can say it works 24X7X365 for years and years, if you give it proper respect. it will never disappoint you, it is very strong that way. It's tough not that fragile as we think, in plain words even after so much insult like smoking , junk food and so much of professional , social or familial stress in these times, it keeps on beating but when you cross the limits it yields and then you can not mollify it . So your words are true, eat well, do some exercise and try to be happy with whatever you have.Cheers!
Dr Vijay Kumar Gupta
Intesivist Anaesthetist

Professor Shanker Dutt said...

I had been told by a wise doctor many moons ago that 60 ml of Single Malt is the cleanest fuel for the heart. Sadly with our salaries, families and other animals, we seek inferior substitutes.

Manoje Nath said...

happy to hear a dpoctor reassuring us against the scare mongering compaign . thanks.

Unknown said...

As usual,interesting and entertaining.But matters of the 'heart',whether physical or otherwise,need to be taken seriously!So also Doctor's advice.In so far the explanation given, as to why some body succumbed and how the other made it by following medical advice goes,it may be prudent to give the Physician his due even though we may like to do something else!Despite advances in medical science predicting life and death everytime will continue to be an enigma and a mystry?That is why life is so enchanting!!Happy Blogging.

Manoje Nath said...

your point is well taken.

BMD said...

Sir, As a chain smoker and a heavy drinker your blog entry comes as a major relief!
This is 21st Century LSD: Anything you suffer from is attributed to Life Style Disease (LSD)!
The genetic stuff at least as of now, combined with great basic care on early childhood health, games and WATSAN, seem to have more impact than on diet, exercise, and mumbojumbo in middle age!

Manoje Nath said...

Modern health care industry seems to treat death as one more disease to be conquered just as tuberculosis,lobar pneumonia,typhoid etc. statistical data are cited in support of any number of hypothesis which are valid till the next interpretation of the same data.the bottom line is in the long run all of us are dead .

p.s i must add a caveat : too many people seem to be taking the piece a little too seriously. the original idea however was to have some fun at the cost of my cardiologist friends.they are a noble lot and their advice must be taken seriously seriously.

BMD said...

A good book is "Death can be conquered and 99 other medical hypotheses". It is a serious book with some way-out hypotheses. Like you mentioned, a couner-intutive hypothesis quoted in this book is that quitting smoking cold turkey increases the chances of cancer- based on a study in Karnataka. Keeping with the 'spirit' of the piece let me then say I'd prefer Dr. Naresh Trehan as my cardio: apparently he smokes!

shankarsharan said...

The heart is famously fickle Its muscles may be strong its software is not. We must not worry too much about hardware more about software as theginclined to err. A that is splendid in life comes springing from the heart, but often at a faster wear and tear of the hardware. While we should not ignore the latter let us live a full life and float with the heart before sinking with the heart. Let us remember jealousy and vanity and ambition can consume the heart as fast as nicotine and alcohol or spices or high cholesterol. Let the heart keep us alve both ways with beauty and health. what pleases my head best is a life of the mind, my heart compassion enriched as it is by human touch
shankar sharan

shankarsharan said...

The heart is famously fickle Its muscles may be strong its software is not. We must not worry too much about hardware more about software as theginclined to err. A that is splendid in life comes springing from the heart, but often at a faster wear and tear of the hardware. While we should not ignore the latter let us live a full life and float with the heart before sinking with the heart. Let us remember jealousy and vanity and ambition can consume the heart as fast as nicotine and alcohol or spices or high cholesterol. Let the heart keep us alve both ways with beauty and health. what pleases my head best is a life of the mind, my heart compassion enriched as it is by human touch
shankar sharan

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ajoyipsbhr85 said...

death is a one time certainty... and the quicker it is the better....!
my mom had all possible kinds of heart valve ailments since 1978, we planned valve replacement in 1981... Thanks to Dr. George Cherian of CMC Vellore, we allowed her to carryon with the God made one, and she died only a few days back... i am a witness to her heart racing at about 180 beats per min for over an hour.... while it was racing, her limbs turned dead cold... but her heart survived even that.... and she had to remain in coma for over 8 days, before the heart finally gave way.... death was so difficult and painful for her, and for us, watching her helplessly, struggle.....!!
my father passed away peacefully in his sleep, and i dont know whom to thank his heart or ....!!
when death is a certainty and no one can predict that s/he will live to watch the sunrise tomorrow, one should live each day as the last...!
and Doctors also have to earn their bread and meat, butter and jam, and what better way for them than causing scare and asking the poor patient to dish out money willingly....!!
heart is the only source of happiness and ur article pleases it abundantly... pl keep going...!!
and please allow ur heart to keep going, which tolerates the daily dose of Zoo Survey undertaken on foot, in the company of the inmates...

ajoyipsbhr85 said...

and one thing the Doctors should add to their scare therapy...!
any breakdown of the Internet Connection (howsoever shortlived) is a sure way of breaking kids heart... and that the Service Provider should be booked for section 307 IPC [attempt to murder] in all such events, should be the Medico-Legal advice....!
are any Cardiacs listening..?

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